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U.S. NAVY i 
MEDICINE • 




December 1979 




VADM Wlllard P. Art nt/en, MC, DSN 

Surgeon General of the Navy 

RADM H, A, Sparks, MC, USN 
Deputy Surgeon General 



Director of Public Affairs 

LTJG Richard A. Schmidt, USNR 

Editor 

Jan Kenneth Herman 

Assistant Editor 
Virginia M. Novinski 

Editorial Assistant 

Nancy R. Keesee 



Contributing Editors 

Contributing Editor-in-Chief: CDR E.I. Tay- 
lor (MC); Dental Corps: CAPT R.W. Koch 
(DC): Education: LT R.E. Bubb (MSC); Oc- 
cupational Medicine: CAPT J J. BeHanca 
(MC); Preventive Medicine: CAPT D.F. 
Hoeffler (MC) 



POLICY: U.S. Navy Medicine is in official publication 
or (he Navy Medical Department, published by the Bureau 
of Medicine And Surgery. It disseminates » Navy Medical 
Department personnel official and professional informal Ian 
relative to medicine, dentistry, and the allied health sci- 
ences. Opinions expressed are those of the authors and do 
not necessarily represent the official position of the Depart- 
ment of the Navy, the Bureau of Medicine and Surgery, or 
any other go vera mental department or agency. Trade 
names are used for identification only and do not represent 
an endorsement by the Department of the Navy or the Bu- 
reau of Medicine and Surgery. Although U.S. Navy Medi- 
cine may cite or extract from directives, official authority for 
action should be obtained from the cited reference. 

DISTRIBUTION: U.S. Smvy Medicine is distributed to 
active-duty Medical Department personnel via the Standard 
Navy Distribution list. The following distribution is author- 
ized: one copy for each Medical, Dental, Medical Service 
and Nurse Corps officer; one copy for every 10 enlisted 
Medical Department members. Requests to increase or de- 
crease the number of aliened copies should be forwarded to 
VS. Nwy Medicine via the local command. 

CORRESPONDENCE: AIL correspondence should be 
addressed to: Editor, US. Navy Medicine, Department of 
the Navy, Bureau of Medicine and Surgery (MED 001 D). 
Washington, D.C. 20372. Telephone: (Area Code 202> 254- 
4253, 254-4316. 254-4214; Autovon 294-4253. 294-431b. 294- 
4214. Contributions from the field are welcome and will be 
published as space permits, subject to editing and possible 
abridgment. 

The issuance of this publication is approved in accordance 
with Department of the Navy Publications and Printing 
Regulations (NAVEX05 P 35). 



U. S. NAVY 
MEDICINE 



Vol. 70, No. 12 
December 1979 



1 From the Surgeon General 






NAVMHD P-5MS 



2 Features 

NASA Astronaut is a Navy Medical Officer and the First American 
Physician in Space 
J.K. Herman 

8 The Navy in Antarctica: Operation Deepfreeze 
CAPTN.S. Howard, MC, USN 

10 Professionalism in Health Care Administration: ACHA Admits 
MSC Members 
LTG.J. Spinks. MSC, USN 

12 MSC: Not Always Medical Service Corps — Sometimes It's Mili- 
tary Sealift Command 
CAPTB.R. Blais, MC, USN 
CDR E.J. Sullivan, MC, USN 
CDR M.O. Abbott, MC, USN 

16 Emotional Disorders of Learning 
CDR E. Breger, MC, USNR 

18 Education and Training 

Refresher Training for Submarine Hospital Corpsmen: A Working 

Model 

CAPTB.D. Button, MC, USN 

21 Notes and Announcements 

22 Professional 

A Podiatric Blunt Dissection Technique for Plantar Wart Removal 
LTR.A. Warcholak, MSC, USN 

26 Occupational Lung Disease 

CAPT T. V. McManamon, MC, USN 

28 BUMED SITREP 

29 INDEX Vol. 70, No. 1-12, January-December 1979 

COVER: Skylab Astronaut CDR (now CAPT) Joseph P. Kerwin, MC, 
USN, suited and ready to leave for the Kennedy Space Center launch 
complex. — NASA photo 
Story on page 2. 



FROM THE SURGEON GENERAL 



A Measure of Our Readiness 



The naval service, the Navy and 
Marine Corps, has always been 
among the first United States forces 
to respond in any national emer- 
gency. On these occasions, the 
Medical Department of the Navy 
demonstrated its readiness and re- 
sponded with alacrity. 

Our readiness to respond has al- 
ways been a source of pride to us, 
and justifiably so. 

During times of peace we train in 
our hospitals, clinics, and schools, 
sharpening our skills and preparing 
ourselves. We work very hard and 
the results of our efforts have been 
proved repeatedly. We can expect 
to be challenged again so let us con- 
sider, briefly, our readiness. 

During 1978 we had the opportu- 
nity to measure our ability to re- 
spond to a crisis. Through an exer- 
cise called Nifty Nugget, we ex- 
plored readiness issues, identifying 
those areas where we might im- 
prove, and developing actions to 
accomplish these improvements. 

With the impetus of Nifty Nugget 
we were able to identify potential 
conflicts in personnel management 
during crises. The Marine Corps 
must be augmented with medical 
personnel to bring it to combat 
strength before deployment. Aug- 
mentation is managed by the Bu- 
reau of Medicine and Surgery. 
Mobilization, which is managed by 
the Navy Military Personnel Com- 
mand (NMPC), can occur before, 
during, or after the Marine Corps is 
augmented, creating havoc in the 



personnel management system. 
This occurs when both BUMED and 
the NMPC start writing orders on 
the same personnel. This was a 
major problem and it has now been 
resolved. Augmentation of the Ma- 
rine Corps has the highest priority. 

During Nifty Nugget we were re- 
minded again of the essentiality of 
surgical team supply block readi- 
ness. Reserve surgical teams are 
mobilized and espoused to the sur- 
gical team supply blocks maintained 
by the medical centers. The mobi- 
lized teams must immediately be 
ready for reassignment as the situa- 
tion requires. It is very clear from 
this example why surgical team 
supply blocks must receive as much 
attention as is required to maintain 
the blocks at 100 percent readiness. 

Exercise Nifty Nugget gave us 
the opportunity to include all Medi- 
cal Department commands in realis- 
tic exercise play. The response was 
excellent. 

There will be more exercises like 
Nifty Nugget. To prepare for these 
exercises and to insure our readi- 
ness for actual contingency opera- 
tions, several initiatives have be- 
gun. 

During the last year, personnel re- 
quirements to support contingency 
operations have been identified. 
Training for those requirements has 
been considered and curricula are 
being developed. 

Specific contingency skills, such 
as methods of triage and care for 
mass casualties, are being incorpo- 



rated into the training requirements 
for certain categories of personnel. 

Plans are being developed for 
courses of instruction to indoctri- 
nate Medical Department personnel 
in both peace and wartime contin- 
gency skills. 

Mobile Medical Augmentation 
Readiness Teams (MMART), the 
new, rapid response surgical and 
support teams concept, will have a 
training package soon. This innova- 
tive training concept will employ in- 
service training, exercises, and 
actual deployments to guarantee 
readiness to support either peace or 
wartime contingencies. 

I believe it is clear from the 
activities, exercises, and initiatives 
discussed here that 1 am deeply con- 
cerned about our readiness in the 
Medical Department. You too must 
show your concern by maintaining 
your professional skills and your 
physical fitness, by keeping your 
immunizations current, and by 
keeping your personal affairs in 
order. 

Readiness requires effort from 
everyone. Readiness is a responsi- 
bility and an obligation we must all 
seek to fulfill. 

This is my goal and it should be 
yours. 




W.P. ARENTZEN 

Vice Admiral, Medical Corps 

United States Navy 



Volume 70, December 1979 



NASA Astronaut is a Navy Medical Officer 
and the First American Physician in Space 



Before it plunged to earth in a 
shower of flaming pieces last sum- 
mer, the Skylab spacecraft served 
as home, workshop, and orbiting 
laboratory for three U.S. crews. The 
1 18-foot-long, 100-ton vehicle con- 
tained 13, 000 cubic feet of living 
and working space, about the same 
interior living space as a three- 
bedroom house. There were private 
sleeping compartments for the 
crew, a dining table, shower, toilet, 
and an 18-inch porthole for viewing 
the Earth and stars. One ton of food 
and 720 gallons of drinking water 
provided nourishment for three 
missions. 

When it was launched in May 
1973, Skylab was slated to perform 
many missions. Its sophisticated 
telescopes, cameras, and sensors 
would study the Sun, stars, and the 
Earth below. From the Earth data 
alone, scientists hoped to find ways 
to monitor and later develop the 
planet's vast resources. 

Most importantly, Skylab would 
test man 's ability to live and work 
for extended periods in a zero-grav- 
ity environment. With this last goal 
in mind, NASA chose a Navy physi- 
cian, CDR (now CAPT) Joseph P. 
Kerwin to be a member of the first 
crew. As scientist-astronaut, he 
would monitor the crew's health 
and conduct a series of medical ex- 
periments to determine: 

• the effects of weightlessness on 




Dr. Kerwin 

man 's ability to perform mechanical 
tasks, 

• assess the effects of long expo- 
sure to zero gravity on the cardio- 
vascular system, 

• determine whether normal 
sleep rhythms such as sleep and 
wakefulness are influenced by zero 
gravity and a rapid day-night cycle, 
and 

• study nutritional requirements. 

The mission plan was to launch 
the Skylab into a 270-mile-high orbit 
and get it functioning smoothly. A 
day later, the astronaut crew of 
Charles "Pete" Conrad, Joseph 
Kerwin, and Paul Weitz would be 



launched, and after rendezvous and 
docking would enter the space sta- 
tion to begin their 28-day mission. 

Disaster threatened from the be- 
ginning. During launch and orbital 
insertion, the Skylab suffered seri- 
ous damage. A shield designed to 
protect the crew from meteoroids 
and the Sun 's heat tore loose. 
Equally threatening was the loss of 
one of two solar panel arrays. The 
remaining panel had refused to fully 
deploy, providing the space station 
with but a fraction of its energy re- 
quirements. 

NASA delayed the astronaut 
launch for 10 days as scientists and 
engineers at NASA facilities in 
Houston, Huntsville, Ala., and the 
Kennedy Space Center worked 
feverishly and around the clock to 
save the stricken Skylab. 

When Conrad, Kerwin, and 
Weitz finally blasted off on 25 May 
1973, they carried with them the 
simplest yet the best tools American 
imagination and ingenuity could 
devise. 

After deploying an umbrella-like 
sunshade and freeing the stuck 
solar array with a hair-raising extra- 
vehicular space walk, the elated 
astronauts had the Skylab mission 
back on track. 

U.S. NAVY MEDICINE recently 
visited Dr. Kerwin at his home base 
— the Johnson Space Center in 
Houston — where he is presently in- 



U.S. Navy Medicine 



volved in the Space Shuttle pro- 
gram. 

Before being selected as a scien- 
tist-astronaut in 1965, the now 47- 
year-old Oak Park, III, native was 
flight surgeon with a Marine air 
group and a naval aviator. He 
earned a reputation among his 
NASA colleagues as the most wide- 
ly read of the astronauts. During his 
28-day stay in Skylab, he relaxed in 
his off hours by listening to classical 
music and reading books on his 
favorite subject — science fiction. 

This is the first of a three-part 
interview with Dr. Kerwin. 

USNM: Were you, in fact, the first 
physician in space? 
Dr. Kerwin: No. I was the first 
American physician in space. The 
Russians launched a physician way 
back in the mid 1960s. His name 
was Boris Yegaroff. He was up for a 
whole 24 hours but something went 
wrong with the spacecraft. It 
sounded like a flight that was sup- 
posed to last considerably longer 
than one day but they brought it 
back after one day. Boris never flew 
again. One of my colleagues met 
him several years later over in 
Russia and described him as a 
Soviet version of a hippie. He was 
the sport-shirted, free spirit — prob- 
ably a little bit on the outs with the 
establishment already. I think they 
have flown a physician subsequent- 
ly, although not in a medical 
capacity. 

You must have some strong feel- 
ings about being the first. 

It's a lot of fun to do something 
first. But I must say that space 
flight is so impressive an experi- 
ence, that it's worth doing whether 
you are the first or not. Being on the 
first Skylab flight was a good feel- 
ing, even though the flights were 
equally challenging — in fact, all the 
Skylab flights were almost carbon 
copies of each other. It was fun to be 




Skylab crew blasts off from the Kennedy Space Center for a rendezvous with the 
orbiting space station, 25 May 1973. 



Volume 70, December 1979 



3 



on that first flight. When the Skyiab 
was damaged on the way to orbit, 
we had to throw the whole flight 
plan into the wastebasket and in 10 
days design a new one and go out 
and "save the program." That 
might sound unpleasant, but in fact, 
it was just the opposite. We were 
faced with a challenge. We had a 
bunch of rather crude tools to go up 
there and do a job with. If we suc- 
ceeded, it was a big deal and if we 
didn't, at least we tried hard any- 
way. 

When they initially found that 
things were not going well with the 
spacecraft, yon didn't have much 
time to prepare. 

Very little. In my 15 years at 
NASA, there are two episodes that 
stand out as evidence of a bureau- 
cratic organization functioning 
superbly. One was Apollo 13 which 
was the mission on which the oxy- 
gen tank blew up and the command 
module lost all power. The crew had 
to crawl into the lunar module and 
somehow get back home. The other 
was this Skyiab rescue mission. I'm 
not talking about the inflight por- 
tion of it. I'm talking about the 10- 
day period that began with the first 
sign on telemetry during launch 
that something was wrong with Sky- 
lab. 

What actually had gone wrong 
with the vehicle? 

Around the workshop was wrap- 
ped a sheet of aluminum that 
covered the whole circumference 
with spring-loaded levers under- 
neath. The idea was that once you 
achieved orbit, you would release 
these springs and they would pop 
the whole thing out. It would act as 
a thermos bottle, reflecting the 
Sun's heat. When the shield got 
hot, the interior would remain cool. 

As the vehicle went supersonic 
one minute after launch, a bit of air 
got under the leading edge and 



ripped it clean off in a tenth of a 
second, taking with it one of the 
solar panels at the shoulder and 
dumping it into the Atlantic Ocean. 
It ripped around until it got to the 
other panel and, fortunately, in- 
stead of taking that panel off, the 
shield just ripped and left a frag- 
ment of itself under this panel 
which remained in place. Scraps of 
aluminum from the ripped shield 
wrapped themselves over the top of 
the solar panel and riveted them- 
selves into it, preventing it from de- 
ploying. 

Once in orbit, the temperatures 
began to climb and when the con- 
trollers commanded the panels to 
deploy, they got no response at all 
from the right panel which was no 
longer there. From the left panel, 
they got a signal that it was un- 
locked. It opened about a foot and 
they got just a trickle of voltage 
from the solar panels, just a small 
portion of which were exposed. 

In short, we had a vehicle that 
was extremely warm with just a 
trickle of electrical power. We had a 
third set of panels that did deploy 
normally. 

For 10 days the controllers played 
a game with Skyiab, turning its nose 
to the Sun in order to cool the 
surface. But when it was nose to the 
Sun, the solar panels didn't see the 
Sun and we lost all power. The goal 
was to find a compromise attitude 
that would keep it cool enough yet 
would still give it enought power to 
keep it alive so it could be con- 
trolled. 

Meanwhile, on the ground, they 
began to think of ways to free the 
solar panel but, even more impor- 
tantly, something to put over the 
top of the workshop to reflect the 
Sun. We came up with a parasol and 
a sail. We had three different con- 
cepts. All three were invented, 
designed, built, tested, packaged, 
and shipped to the Cape in 10 days. 

On launch morning, we walked 



up the gantry into the command 
module and there was this big, 
brown blanket right under the seats 
with all these lumps and bumps in- 
side of it — all this equipment, half 
of which we had never even seen in 
our lives and a little checklist that 
said what to do with it. 

Did yon ever get a chance to test 
any of it? 

Some of the equipment we got to 
evaluate in the development stage. 
One of the first things we did was to 
fly back to Houston from the Cape. 
We split up the crew. One guy took 
this concept, one guy took that con- 
cept, and we worked the crew inter- 
face. How are we going to use this 
thing? 

I got to go to Marshall Space 
Flight Center, broke my quarantine, 
and went in the water tank in the 
space suit and started evaluating 
means of going EVA (extravehicular 
acitivity) and deploying a sail, I 
worked with that for two or three 
days and then one of the backup 
crew boys took over and we went 
back to the Cape and regrouped as a 
crew. 

Did you actually get to work with 
the parasol concept?' 

I wasn't working with the parasol. 
I worked with what they called the 
Marshall Sail. Of the three con- 
cepts, we used two. The second day 
in orbit, we deployed the parasol 
which was an umbrella-like thing 
we pushed through an airlock in the 
wall of the workshop. We didn't 
have to go EVA to deploy that. It 
was four fishing poles on a rod col- 
lapsed together like an umbrella 
with the material all folded in 
around it. You just pushed it out. As 
soon as the poles were free of the 
workshop walls, they were spring- 
loaded to come out flat, like an 
umbrella. We raised it and lowered 
it and jiggled it to make the folds 
and wrinkles come out and rotated it 



U.S. Navy Medicine 




An oral physical examination in space is a unique experience. 



NASA photo 



until it covered as much of the work- 
shop as it could be made to cover. 
That worked satisfactorily and we 
brought the temperatures down 
from 130° inside to about 85°. From 
there, they varied as a function of 
Sun time. 

When the second crew went up 
they took the Marshall Sail which 
was a sturdier, larger device that 
had to be taken out by two suited 
crewmen and deployed. We could 
have done that on the first flight. In 
fact, we kept asking for it because it 
was so much fun to go EVA. But 
they decided we had done, enough. 
The second crew would do that. 

When you went out on your first 
EVA, it was to get rid of the alumi- 



num scrap jamming the solar panel. 

The first thing we did was deploy 
the parasol. Then we worked in the 
Skylab as long as we could. We then 
had about 12 days to do as much of 
the flight plan as we could, eating 
the food cold, turning lights out 
whenever we exited a compartment 
— saving power. We could do the 
medical experiments because they 
were low power users. We could do 
some of the solar physics work, as 
long as we didn't power up too 
many experiments at a time. We 
couldn't do the Earth resources 
photography at all . We tried it once 
and red lights went on and all the 
batteries lost their charge. It was a 
disaster. We did the best we could 
for about two weeks. 



Meanwhile, the guys on the 
ground, using our reports, began 
evaluating the situation. We had 
first-hand damage surveys. The 
first thing we did when we got to 
Skylab was to fly around it in the 
command module and take a lot of 
TV. We also described exactly what 
the situation was. Knowing what 
tools we had on board in part of this 
sea of brown rope that we had in the 
command module, was a batch of 
tools that we had randomly selected 
from a large table about five days 
before launch. They had gotten to- 
gether every tool they could think 
of, mostly from the local Bell Tele- 
phone Company. We had a cable 
cutter that's remotely actuated by 
pulling on ropes.' We had five or six 



Volume 70, December 1979 



SKYLAB ORBITAL WORKSHOP 



ENVIRONMENTAL 
CONTROL SYSTEM 



SKYLAB STUDENT 

EXPERIMENT 

ES-5! WEB FORMATION 

OPERATIONAL MODE 



FOOD FREEZER 



FORWAitD 
COMPARTMENT 



FRENCH 
ULTRAVIOLET 

EXPERIMENT 



EARTH OBSERVATION 
WLNDOW 

WAKDKOOM 



SKYLAB STUDENT 
EXPERIMENTS 



FOOD TABLE 



EXPEWMESiT 
COMPARTMENT 



WASTE DISPOSAL 
SHOWER 




ENTRY HATCH 4 
AIRLOCK INTERFACE 



LOCKER STOWAGE 



WATER SUPPLY 



WASTE MGT ODOR 
FILTER 



BODY WEIGHT DEVICE 



WASTE 

MANAGEMENT 
COMP 

FECAL-URINE 
SAMPLING 

SLEEP 

COMPARTMENT 



WASTE T-5-.k 



MICROMETEHOID 
SHIELD 



five-foot sections of aluminum pole. 
We had shepherd's crooks and saws 
— whatever we might need to go out 
there and do the job. 

The backup crew on the ground 
went into the water tank, mocked up 
what the problem was, selected 
tools, and designed an EVA for us. 
We rehearsed that on the 13th day 
inside. We cut the ropes, put the 
poles together, and practiced what 
we would do. On the 14th day we 
went out and did it. I figured when 
we went out that we had a 50-50 
chance. The problem was that the 
damage was down in an area of the 
workshop where there were no 



NASA photo 

handholds, no footholds, no rails, 
no way to get there, and no way to 
stabilize our bodies while we were 
working. But we got around that by 
hanging on to each other's legs — we 
had a lot of fun up there. 

Your heartbeat went up to 150 at 
one point. 

It was the frustration of holding 
those 25-foot poles with the cable 
cutter on the end, with no stabiliza- 
tion and trying to get those jaws 
hooked onto the scrap of aluminum. 
Once we got it hooked, we could use 
the pole as a handrail and get down 
there and do our business. We 



finally figured out how to stabilize 
ourselves. There was a little eyelet 
at the base of one of the antennas 
just about in the right place. We 
took a rope of the right length, 
hooked it to my suit, down through 
the eyelet, back up, and hooked it 
again on the suit. Then all I had to 
do was stand up against it. It was 
short enough to give me a third foot. 
Suddenly, I was stable and not float- 
ing anymore, as long as I kept my 
legs taut. Klunk, out she went; we 
tightened the jaws down, crawled 
out there, fastened some ropes to 
the solar panel, then finished 
cutting through the last scrap. Once 
that was loose, the thing was ready 
to come up. But the hydraulic 
mechanism was frozen. We took the 
rope we had fastened to it and both 
of us just got between the rope and 
the surface of the workshop, and 
stood up, thus putting tension on 
the rope. We stood up and pulled 
and pushed, and bang, it came free. 

Did it pop oat suddenly? 

It suddenly popped and came 
loose. Both of us went flying in dif- 
ferent directions — on our tethers 
of course. By the time we both got 
stabilized and turned around, there 
she was, fully up, and the panels 
were slowly beginning to come out. 
It took them about four hours to 
come out all the way. By that after- 
noon, we were wallowing in elec- 
trons. 

When yon got on board, what did 
yon find? 

Before we got there, the ground 
remotely commanded the opening 
of a dump valve and dumped all the 
air out of Skylab. They then closed 
the valve and backfilled it again 
with oxygen and nitrogen one time. 
That's all the oxygen we could 
spare. They still weren't sure that it 
was safe. We carried up samplers, 
space versions of the old mining 
sniff tube — just a glass tube with a 



U.S. Navy Medicine 



chemical indicator. You pull air 
through it with a pump and watch 
for a color change. We tested the air 
in the workshop before we opened 
the door. We did it through a little 
vent valve on the hatch. The test 
turned out negative so in we went. 
The air had a smell to it — a burn 
smell from the excessive heat which 
I'll never forget. 

How hot was it? 

About 130° that first day, about 
like the engine room on a ship. 
You'd go down into the workshop, 
work for 15 or 20 minutes, and then 
come back to the north end of the 
vehicle near where the command 
module was docked. Actually, it was 
quite cool down there. 

What other things did you find 
wrong when you got aboard? You 
obviously had the heat problem and 
there was some fear that the film 
may have been damaged or mined. 

The heat hadn't damaged the 
film. Later in the mission, the radia- 
tion began to fog the film, even 
though it was stored in a heavy 
aluminum and lead film box, one of 
the heaviest things in the Skylab. 

Some of the food had been ruined 
by the heat. Amazingly, the frozen 
food hadn't. There was enough 
power to keep the freezer going. 
Some of the food such as the catsup 
which was stored in those little 
plastic pouches they have in restau- 
rants, was all smelly and runny. At 
130° it just went bad. 

Some of the batteries and battery 
chargers had failed. That was about 
it. 

There was some concern that 
some of the vitamin content of the 
food had been destroyed by the 
heat. We took some food samples 
back with us but I don't think the 
assays were good enough to deter- 
mine the vitamin content. I suspect 
that we were a little short on 
vitamins and that was one of the 



reasons why we had some blood loss 
and some skin changes — very mild 
— but things that the other crews 
didn't have. In fact, they sent them 
up with big bottles of vitamins and 
they popped them every day just to 
make sure. 

Back in the 60s, there were some 
ideas about what effect prolonged 
weightlessness would have as far as 
loss in bone density, red cell loss, 
etc. The cosmonauts were known to 
have experienced some ill effects. 
Did your mission or any of those 
subsequent to it demonstrate any of 
this? 

Oh yes. I think we have a very 
accurate description of the syn- 
drome now. We aren't so sure about 
the treatment but we can describe 
very accurately what happens to an 
adult, male, human being who 
spends one three-hundredth of a 
lifetime in weightlessness. Some of 
the changes are profound, consider- 
ing the maturity of the organism. 
There is an immediate shift of blood 
and interstitial fluid from the lower 
to the upper half of the body, a 
growth of an inch to an inch and a 
half in size, just due to the unload- 
ing of the vertebrae. There is a 
dumping of fluid. When this fluid 
shifts, fluid that's normally trapped 
in the legs by gravity enters the 
circulation, increases the central 
venous pressure, dilutes the blood, 
and is excess baggage in weight- 
lessness. You diurese or perspire it 
out and within 48 to 72 hours the 
body has lost three or four pounds 
of weight — totally fluid. The venous 
and pressure dynamics of the body 
have now returned to something 
approaching normal. But the blood 
is now concentrated. The hemoglo- 
bin is a few grams higher than 
normal. The bone marrow, now 
being hemoconcentrated, quits 
making red cells. We don't know 
what the signal pathway is. The 
body then becomes anemic. Red 



cells are not being destroyed abnor- 
mally but normal destruction is 
reducing the red cell count until, 
after three, four, or five weeks, the 
concentration in weightlessness is 
normal again. Red cell production 
then begins at a lower rate and 
maintains "normal" concentration. 

When you return to earth after 
four weeks, you have lost plasma 
volume, interstitial volume, and red 
blood cells. You come back to 
gravity and immediately all this 
fluid is again trapped in the legs 
and the body is now in mild shock. 
You're low a few pints of blood. 
This accounts for the orthostatic in- 
tolerance, and explains why men 
returning from space traditionally 
have been a little unsteady on their 
feet. They are also unable to exer- 
cise very well, have a tendency to 
have an increased heart rate, and a 
lower blood pressure in the upright 
position; they can't tolerate stand- 
ing very well initially. 

But all this is physiological. It's 
adaptive rather than pathological. 
Within 48 hours on the ground, the 
fluid volume is back to normal; 
thirst takes care of that. The red cell 
production is much slower to come 
back to normal and the body is 
slightly anemic for the first four or 
five weeks, but not noticeably. 

The interesting thing about all 
these cardiovascular changes is that 
they are rapid, relatively profound, 
and very noticeable. But they are 
time limited. They go so far and no 
further. They are not a concern for 
long duration space flight. The 
same thing is true with changes in 
the vestibular system, and the 
balance mechanisms. You get pro- 
found subjective changes in the way 
that apparatus works. It has to 
adapt to a whole new environment. 
It causes motion sickness on some 
of the crew early in the flight. But 
that's all over and done with in a 
week or 10 days. (To be continued in 
the January issue) 



Volume 70, December 1979 



The Navy in Antarctica 



Operation Deepfreeze capt 



Noel S. Howard, MC, USN 



The close of last month marked the 
50th anniversary of Admiral Richard 
E, Byrd's historic first flight over 
the South Pole in November 1929. 
This occasion gives us pause for re- 
flection regarding the continuing 
involvement of the Navy in general 
and the Navy Medical Department 
in particular in "Operation Deep- 
freeze." 

Historically, the Antarctic Conti- 
nent has been held in an ambivalent 
awe since antiquity when its exis- 
tence was a matter of speculation. 
Indeed, Admiral Byrd warned, 
"Any man who elects to inhabit 
such a spot must reconcile himself 
to enduring the bitterest tempera- 
tures in nature, a long night as 
black as that on the dark side of the 
moon, and an isolation which no 
power on earth can lift for at least 6 
months (the Antarctic winter from 
February to September or later. "(2) 

The International Geophysical 
Year (1957-1958) ushered in a new 
era of intensified, international, 
peaceful, cooperative, scientific ex- 
ploration of the Antarctic Continent. 
The Antarctic Treaty (1969) is a re- 
flection of this thrust. Technological 
developments have materially re- 
duced the risk of physical exposure 
in that extreme environment.there- 
by allowing productive research in 
such areas as meteorology, geo- 
physics (gravity, cosmic rays, etc.), 
geology, biology, medicine, and 
engineering. 

Currently, the United States 
maintains four stations in Antarctica 



Dr. Howard is head, Mental Health Pro- 
grams Branch, BUMED (MED 3121) and is 
in charge of Psychiatric Screening for Opera- 
tion Deepfreeze. 



on a year-round basis: McMurdo — 
the largest, Palmer, Siple, and 
South Pole. Taken as a group, these 
stations annually provide winter- 
over accommodations for approxi- 
mately 42 civilians, including about 
23 scientists and in excess of 60 (in- 
volved in communications, trans- 
port, electronics, medical support, 
and other support functions) Navy 
personnel — with a potential to sup- 
port many times that number. On 
occasion, additional American ex- 
change scientists may winter-over 
at a "foreign" station (e.g. Russian 
[Vostok] and Polish stations) and 
vice versa. Overall program respon- 
sibility falls to the National Science 
Foundation (NSF) with logistic sup- 
port provided by the Navy (Naval 
Support Force Antarctica (NSF A)). 



Since the mid-1960s, the Navy 
has studied psychologic/behavioral 
adaptation within the aforemen- 
tioned relatively small, isolated 
groups. In the wake of pioneering 
work in this area, (2-7) BUMED with 
the cooperation of NSFA and NSF 
has conducted psychiatric debrief - 
ings of winter-over personnel on 
site at the South Pole (and other 
stations on occasion) at the conclu- 
sion of winter-over (between mid- 
October and mid-November) on 
nearly an annual basis for the past 
decade. Such has indicated that, 
while the overwhelming majority of 
people surveyed have adapted quite 
well psychologically during their 
winter-over experience, and would 
be judged "successful," stresses 
associated with isolated small group 




Entrance to Pole Station during the height of International Geophysical Year (IGY) 
activity. 



8 



U.S. Navy Medicine 




Photographing ice formations near McMurdo Sound. 



living can produce explosive con- 
sequences particularly in the pres- 
ence of overt psychiatric illness, 
alcoholism, or character traits such 
as paranoia, rigidity, intolerance of 
differences, and high excitability. 
Moreover, a variety of "nondis- 
abling" psychiatric symptoms tend 
to occur with some frequency in- 
cluding disturbed sleep, depres- 
sion, irritability, and impaired cog- 
nition. This collective experience 
has been incorporated into our 
screening process. Each candidate 
for winter-over in Antarctica 
(whether military or civilian) under- 
goes a rigorous medical screening 



process conducted by the Navy 
Medical Department including 
physical and laboratory examina- 
tions, health record/ history review, 
and a thorough psychiatric assess- 
ment. The latter consists primarily 
of questionnaire completion and two 
interviews — one with a psychiatrist, 
the other with a psychologist. 
Further details concerning the psy- 
chiatric evaluation will be the 
subject of a subsequent article. 

In summary then, the barren, 
frozen frontier which Admiral 
Byrd's historic flight helped to 
breach has born fruit in terms of 
scientific research and international 



cooperation in which Navy logistic 
support and Navy medicine con- 
tinue to play an integral role. 

References 

1. Byrd RE: New York, Putnam, 1938. 

2. Mullin CS: Some Psychological As- 
pects of Isolated Antarctic Living. Amer J 
Psychiatry 117:323-327, Oct 1960. 

3. Palmai C; Psychological Observations 
on an Isolated Group in Antarctica. Brit J 
Psychiatry 109:364-370, May 1963. 

4. Solomon P, et al (eds): Sensory De- 
privation. Cambridge, Harvard, 1965. 

5. Gunderson EKE: Mental Health Prob- 
lems in Antarctica. Arch Environ Hlth Vol. 
17, Oct 1968. 

6. Nelson PD: Psychological Aspects of 
Antarctic Living. Mil Med 130:485-489, May 
1965. 



Volume 70, December 1979 



a 



Professionalism in Health 
Care Administration 

ACHA Admits MSC Members 



LT Gary J. Spinks, MSC, USN 

Most individuals participating in 
health care administration would 
probably not hesitate in labeling 
this career a profession rather than 
an occupation. Indeed, this perspec- 
tive of health care administration 
seems to be intuitively correct. 
However, to legitimately classify 
health care administration as a pro- 
fession, it must be determined that 
the accepted characteristics of a 
profession are present. 

The concept of a profession is 
well documented in the literature 
and a number of specific, identifi- 
able traits are available for compari- 
son. It is generally agreed that a 
profession requires expertise based 
on an extensive body of knowledge. 
This knowledge is highly technical 
and requires a long period of train- 
ing to be mastered, (i) Examples of 
this type of knowledge in health 
care would be the Accreditation 
Standards of the Joint Commission 
Accreditation of Hospitals (JCAH), 
various public laws, and within the 
Navy, the Manual of the Medical 
Department, and various directives. 
Clearly, this characteristic is pre- 
sent within contemporary health 
care administration. 

The second characteristic is that 
professions have a "service orienta- 
tion." This means that the objective 
of a profession is to provide the 
public with a service rather than 
products or goods. (2) Health care 
does not involve any one, concrete 



From the Department of the Navy, Bureau 
of Medicine and Surgery (MED 422), Wash- 
ington, D.C. 20372. 



article but rather a variety of 
processes and procedures that re- 
sult in a state of health rather than a 
state of illness. 

The nature of a profession causes 
the individual members functioning 
within it to identify more strongly 
with their profession than those 
practicing nonprofessions identify 
with their occupations. (J) This leads 
to the last characteristic of a profes- 
sion which is that the practitioners 
tend to join together to form 
collegial, professional organizations 
which set standards of behavior for 
that profession. (4) 

It is apparent that health care 
administration meets the above 
criteria of a profession. However, it 
is implied that practitioners in 
health care administration have to 
do more than simply work in the 
field to be considered true profes- 
sionals. Initially, all MSC officers in 
the Health Care Administration sec- 
tion demonstrated their professional 
capabilities. 

Some possessed extensive know- 
ledge and experience gleaned from 
years of naval service while others 
were commissioned after a con- 
siderable educational endeavor 
which culminated in an advanced 
degree in Health Care Administra- 
tion or a related field of concentra- 
tion. Both groups had attained and 
demonstrated the first characteristic 
of a professional. But, how do 
health care administrators acquire 
and retain these traits? Highly tech- 
nical knowledge in this field con- 
tinues to change and grow, de- 
manding an ongoing educational 



process. These requirements can be 
provided by one of the above char- 
acteristics of professions and pro- 
fessionals, namely, that of profes- 
sional affiliation. In this particular 
case, it would be the American Col- 
lege of Hospital Administrators. 

Unfortunately, not all the Navy's 
Health Care Administrators possess 
the requisite education and experi- 
ence to insure their acceptance into 
the American College of Hospital 
Administrators, a society long rec- 
ognized as the most prestigious by 
most health care organizations. To 
those who have achieved this pin- 
nacle, congratulations are in order. 
To those who aspire to College 
membership, hard work and sacri- 
fice are in order. 

The American College of Hospital 
Administrators is — and has been for 
the past 40 years — the professional 
society for those who administer 
health services facilities and pro- 
grams. Administrators have banded 
together in the College to profes- 
sionalize the skills and techniques 
of health service organization and 
administration to assure quality pa- 
tient care. The College provides its 
affiliated with the hallmark of pro- 
fessionalism through certification, 
continuing education, publications, 
referral services, interaction, 
guidance, sponsorship, and repre- 
sentation. (5) By its certification 
process, the College insures that its 
members are professionals in every 
sense of the word. Medical Service 
Corps officers who are graduates of 
acceptable graduate programs in 
hospital or health services adminis- 
tration may apply for membership 
in the College if the applicant: 

• is engaged in a responsible 
administrative position in an accept- 
able hospital, group of acceptable 
hospitals, or a related health activity 
influencing the operations, growth, 
and development of hospitals or 
other acceptable health care ser- 
vices and programs; 



10 



U.S. Navy Medicine 



• meets the eligibility require- 
ments prescribed by the College in 
other respects. 

MSC officers who have not 
earned the master's degree in hos- 
pital or health services administra- 
tion from an acceptable program 
but do possess a related masters 
degree may apply for membership 
in the College if the applicant: 

• is engaged in a responsible 
administrative position in an ap- 
proved hospital; group of approved 
hospitals; an acceptable health ser- 
vices organization or program in- 
fluencing the operations, growth, 
and development of institutions, 
services, or programs of the health 
delivery system; or is affiliated with 
other acceptable health services and 
programs; 

• has had at least one year of 
successful experience in such a 
position; 

• declares his or her intention to 
continue in the field of health ser- 
vice administration; 

• in all other respects meets the 
requirements prescribed by the 
College. 

MSC officers who possess an ac- 
ceptable baccalaureate degree may 
qualify if they meet the above re- 
quirements for a related masters 
degree, but these applicants must 
have at least three years of success- 
ful experience in such positions. (6) 

MSC officers who desire to iden- 
tify with their profession, follow 
certain standards of behavior, and 
continue to pursue education in this 
field, should seek membership in 
this professional organization for 
their personal benefit. 

Acceptance by the American Col- 
lege of Hospital Administrators is 
an unwritten requirement for the 
health care administration profes- 
sion. While membership is volun- 
tary, to be accepted for membership 
is to attain recognition for persever- 
ance and dedication to the ideals of 
this dynamic profession. 



In fiscal year 1979 the following 
MSC officers were admitted to 
nomineeship: 

CDR William L. Blankenship, MSC, USN 

CDR Norman K. Owens, MSC, USN 

LCDR Douglas N. Benander, MSC, USN 

LCDR Milton J. Benson, MSC, USN 

LCDR Philip E. Dould, MSC, USN 

LCDR Leland R. Maassen, MSC, USN 

LCDR John H. Storment, MSC, USN 

LT Jerry T. Anderson, MSC, USN 

LT J. Thomas Benson, MSC, USN 

LT Ronald W. Black, MSC, USN 

LT Douglas S. Delong, MSC, USN 

LT Dennis C. Dunkleman, MSC, USN 

LT Peter P. Garms, MSC, USN 

LT Michel E. Hanson, MSC, USNR 

LT Stephen W. Kaja, MSC, USNR 

LT James T. Kirch, MSC, USNR 

LT John R. Leysath, Jr.. MSC, USNR 

LT Robert S. Peiser, Jr., MSC, USNR 

LT William R. Sattley, MSC, USN 

LT Amance R. Simas, MSC, USN 

LT Terry J. Tingley, MSC, USN 

LT Michael L. Todd. MSC. USN 

LT Joseph P. Van Landingham, MSC, USN 

LT Gale F. Wallace, MSC, USN 

LT John C. Wocher, MSC, USN 

LTJG John F. Clark, MSC, USNR 

LTJG Raymond L. Ford, MSC, USNR 

LTJG William P. Frank, MSC, USNR 

LTJG Jeffrey P. Harrison, MSC. USNR 

LTJG A. Ben Long 111, MSC, USNR 

LTJG Larry T. Mercer, MSC, USNR 

LTJG Donald H. Rosenbaum, Jr., MSC, 

USNR 
LTJG John D. Rudnick, Jr., MSC, USNR 
LTJG James R. Vroom, MSC, USNR 

In order to be eligible for member 
status, an officer must be a nominee 
in good standing for at least three 
years and show evidence of con- 
tinuing professional education and 
growth. To advance in status, 
affiliates must then qualify by pass- 
ing stringent written and oral 
examinations. During fiscal year 
1979, the following MSC officers 
were successfully advanced to 
member status: 

CAPT Francis G. Anderson, Jr., MSC, USN 

LCDR William J. Lambert, MSC, USN 

LCDR Leonard L. Moore, MSC, USN 

LT Kenneth D. Gibson, MSC, USN 

LT Dean A. Hermann, MSC, USN 

LT Patrick L. Mahin, MSC. USN 

LT Gary J. Spinks, MSC, USN 



References 

1. Coe RM: Sociology of Medicine, Mc- 
Graw-Hill, N.Y., 1970, p 190. 

2. Parsons T: "The Professions and 
Social Structure," Essays in Sociological 
Theory, N.Y., Free Press, 19S4, pp 34-49. 

3. Goode WJ: "Community Within a 
Community: The Professions." Am Soc Re- 
view 22:194-200, April 19S7. 

4. Coe RM: op. eft., p 191. 

5. ACHA, Hallmark of Professionalism 
in Heath Services Administration. 

6. ACHA, Regulations Governing Ad- 
missions and Advancements, 



The efficacy of linkage systems in 
health care services, cost contain- 
ment and productivity, manage- 
ment information systems and 
standardized accounting proce- 
dures, public accountability and 
program evaluation are among the 
many complex issues facing all 
health care professionals in our 
society today. In providing health 
care within the naval service, we 
face a professional challenge and a 
unique opportunity for national 
leadership in each of these and 
other related problem areas. 

To meet that challenge, experi- 
ence is vital. But it is not sufficient 
alone. Continuing education is also 
essential, as in our active participa- 
tion in the many professional socie- 
ties of our respective clinical, scien- 
tific, and administrative fields. In 
that regard, I am especially proud of 
the rapidly growing number of Navy 
Medical Service Corps officers who 
are continuing their education and 
advancing in their affiliation with 
professionals of learned societies. 

In that spirit, I express particular 
congratulations to those health care 
administration officers cited in the 
article by LT Spinks, whose ad- 
vancement through credentials of 
the American College of Hospital 
Administrators reflects their profes- 
sional growth, to the benefit of the 
naval service. 

CAPT Paul D. Nelson, MSC, USN 
Chief, Medical Service Corps 



Volume 70, December 1979 



11 



MSC: Not Always Medical Service Corps — 
Sometimes It's Military Sealift Command 



CAPT Bernard R. Bfais, MC, USN 
CDR Edward J. Sullivan, MC, USN 
CDR Mark O. Abbott, MC, USN 



If you were a gambler and someone 
offered to bet that there are nurses 
and civil service employees in the 
MSC, you might jump at it. If you 
did, you would be a loser, although 
you'd be wiser. 

You are correct in believing that 
there are no nurses in the Medical 
Service Corps, since the Nurse 
Corps is a separate corps of the 
Navy Medical Department. You are 
also correct in believing that the 
MSC has only commissioned Navy 
staff officers, and has no civilians. 
But you would have lost your bet be- 
cause you assumed that MSC meant 
the Medical Service Corps. 

Most members of the Navy 
Medical Department automatically 
equate the letters "MSC" with the 
Medical Service Corps. But there is 
another MSC, and its relationship 
with the Medical Department is 
tenuous at best. It has nurses, civil 
service nurses at that, and they 
serve aboard Navy ships. This MSC 
is the Military Sealift Command, 

For some, the letters MSTS may 
conjure up memories. They stood 
for the Military Sea Transport Ser- 
vice, which carried troops and sup- 



Dr. Blais is Surface/Sealift Medicine 
Liaison at BUMED (MED 3C3) and a staff 
medical officer at the office of the Com- 
mander, Military Sealift Command (Code 
M-4M). 

Dr. Sullivan is with the Occupational 
Medicine Division at BUMED (MED 5521). 

Dr. Abbott is Brigade Surgeon, 1st Marine 
Amphibious Brigade. 



plies and later transported depend- 
ents. Established in 1949, it was re- 
named the Military Sealift Com- 
mand, just as the old Military Air 
Transport Service (MATS) is now 
know as the Military Airlift Com- 
mand (MAC). 

While it may be far removed from 
the Medical Service Corps in most 
aspects, the MSC is very much a 
part of the Navy, even though most 
active duty personnel are not famil- 
iar with the command or its opera- 
tions. 

Active duty Navy enlisted person- 
nel are assigned to the Military 
Sealift Command as are line and 
staff corps Navy officers. There is 
even one Marine Corps officer. But 
what seems strange to many active 
duty Navy people who join the MSC 
is the large number of civil service 
employees. There are 4,000 civilian 
sailors in the Navy, all MSC em- 
ployees. Some civilian Marine per- 
sonnel even operate the command 
ships. 

To avoid any misunderstanding, 
the Military Sealift Command is a 
full-fledged component of the op- 
erating forces of the U.S. Navy and 
its commander reports directly to 
the Chief of Naval Operations in 
operational matters. On procure- 
ment and contracting matters, he is 
responsible to the Assistant Secre- 
tary for Navy Manpower, Reserve 
Affairs and Logistics. Overall, the 
Secretary of the Navy is DOD's 
single manager for Sealift. The 
MSC provides vital logistic support 



not only to the Navy and Marine 
Corps, but to all elements of the 
Department of Defense. It also sup- 
ports some other Federal agencies 
as well, such as the National Aero- 
nautics and Space Administration 
and the Agency for International 
Development. 

MSC's Mission 

MSC's ultimate mission is to 
provide sealift for all elements of 
the Department of Defense in con- 
tingency situations. It prepares for 
that mission by delivering military 
cargo worldwide in peacetime. 

Although the MSC's functions 
are many and varied, they may be 
categoried in three general areas: 
delivery of surface cargo, operation 
of Navy Fleet Auxiliary Force ships, 
and operation of Scientific Support 
ships. 

The MSC's cargo operations 
involve point-to-point transport of 
fuel, equipment, ammunition, food- 
stuffs, and all items needed by 
defense units scattered around the 
globe. The MSC, no doubt, had a 
hand in the transportation of your 
auto and household goods when you 
went overseas. In essence, the MSC 
is the Navy operating agency for 
sealift. 

Navy Fleet Auxiliary Force ships, 
22 in number, are MSC-crewed and 
operated but directly support the 
combattant fleet. They supply fuel 
for the ships, equipment and sup- 
plies, including fresh food for the 
people aboard. 



12 



U.S. Navy Medicine 



Oilers and stores ships are regu- 
larly involved in underway replen- 
ishment (UNREP) operations. Fuel 
is generally transferred by hose 
lines, but dry cargo may be trans- 
ferred by high line or helicopter 
using vertical replenishment or 
VERTREP. MSC-operated point-to- 
point tankers also participate in re- 
plenishment operations with the 
Navy fleet. 

Scientific Support operations tend 
to be more exotic. They range from 
tracking NASA's rockets to support 
of oceanographers who map and 
probe the seas from MSC ships. 
Scientific Support ships are de- 
signed and equipped to fulfill a 
variety of special tasks. 

MSC's Personnel 

Personnel involved in operation 
or support of Military Sealift Com- 
mand ships are: 

Active Duty Military — generally 
command staffs or assigned to ship- 
board military detachments aboard 
Scientific Support or Fleet Auxiliary 
Force ships. 

Ships Company — U.S. civil ser- 
vice marine personnel who operate 
all nucleus fleet ships, except for 18 
tankers operated by contractors. 

Ships Company (Chartered Ships) 
— civilian seafarers, but not civil 
service employees of the Navy. 
They are employees of commercial 
shipping firms operating MSC char- 
ters, or firms that contract with the 
MSC to manage and operate tankers 
or roll-on, roll-off ships. 

Technical Crew — May be con- 
tractor employees, civil service 
workers, or active duty military 
personnel. They may be members 
of an organization supported by 
MSC ships, such as NASA, or they 
may be employees of a company 
under contract to the "sponsor." 
The sponsoring organization is, in 
effect, the company that pays the 
cost of these MSC ship operations. 

Active Duty Military Personnel, 




He knows the ropes, cables, and a lot more. Civil service mariner Jerry Kroutchic 
gets things shipshape aboard USNS Passumpsic for the next UNREP operation. 



whether members of Military Sealift 
Command or members of a sponsor 
organization, are managed and 
treated like all active duty military 
personnel. 

Ships Company Personnel, em- 
ployees of Military Sealift Com- 
mand, are part of the excepted ser- 
vice and are seagoing specialists. 
These ship crewmembers are 
unique in that they are eligible as 
U.S. seafarers for certain medical 
services provided by the U.S. Public 
Health Service. Those services are 
roughly analogous to medical ser- 



vices provided by the Navy to active 
duty personnel. As civil service 
employees of the Navy, serving in 
Navy ships worldwide, they are the 
responsibility of the Navy for medi- 
cal services generally provided to 
civil service employees and for 
special services related to their 
special occupation. These services 
are addressed in detail in BUMED- 
INST 6320.52. Medical support of 
Military Sealift Command person- 
nel and others associated with the 
Military Sealift Command are ad- 
dressed in the following directives: 



Volume 70, December 1979 



13 




■ t mK 
USNS Passumpsic refuels the USS Tripoli (LPH 10) underway. This is one kind of UNREP operation. 



Medical Care for Eligible Persons at 
Naval Medical Facilities, BUMED- 
INST 6320.31, Medical Support of 
Military Sealift Command, BU- 
MEDINST 6320.52, Medical Manu- 
al of Military Sealift Command, 
COMSCINST 6000.1 (This is now an 
enclosure of BUMEDINST 6320.52. 
When MSC civil service mariners 
present themselves at a Navy medi- 
cal activity, each should have an 
Individual Sick Slip (Form DD 689), 
identifying the employee, the ves- 
sel, the command, and the charge- 
able account which constitutes 
authorization from the vessel's 
master. Each should have a supple- 
mental medical record, providing at 
least a summary of past medical 
history and treatment, and space for 
recording current examination re- 



sults and treatment. Details of 
physical requirements may be found 
on an included copy of the Certifi- 
cate of Medical Examination (SF 
78). 

Contract Ships Company Person- 
nel are civilians, but not Navy 
employees. Outside the United 
States and its territories they should 
be provided humanitarian treat- 
ment and referred to the area 
husbanding agent for the shipping 
company that employs them. The 
nearest Military Sealift Command 
office or agent will assist in making 
contacts and arrangements. 

In the 48 contiguous states, 
Hawaii, Alaska, Guam, Puerto Rico, 
and the Virgin Islands, humanitar- 
ian emergency treatment should be 
provided with subsequent referral 



to a U.S. Public Health Service 
medical facility. A phone call to the 
nearest Public Health Service facil- 
ity will secure the proper authoriza- 
tion for reimbursement by the 
government for treatment rendered 
and will enable early transfer to a 
Public Health Service medical facil- 
ity. Immediate notification is es- 
sential, as the Public Health Service 
will not reimburse the cost of treat- 
ment in event of after-the-fact 
notification and authorization. 

Technical crew civilian personnel 
also should be given only emer- 
gency humanitarian treatment, 
which is reimbursable by their em- 
ployer. The employer is responsible 
for these civilian employees both in 
the United States and overseas. 
Since they work aboard MSC ships, 



14 



U.S. Navy Medicine 



the cognizant command office or 
agent will assist in contacting the 
employer representative and in ar- 
ranging for whatever disposition is 
indicated. 

The medical problems of civilian 
Marine personnel tend to differ 
from those of young active duty 
military personnel and their de- 
pendents. The average age of a civil 
service mariner is between 48 to 54 
and medical problems of the middle 
aged tend to predominate. Although 
drug abuse is not unknown, it is 
relatively rare. Unfortunately, prob- 
lems with alcohol are not. 

Many civil service mariners sail 
on medical waivers for conditions 
that would render them unfit for 
military duty, especially for chronic 
degenerative diseases and aging 
problems such as hypertension, 
arteriosclerosis, chronic obstructive 
pulmonary disease, obesity, a vari- 
ety of defects left by trauma, dimin- 
ished visual acuity and (except in 
deck personnel) even complete loss 
of vision in one eye. 

Before medical officers react in 
horror at such people being at sea, 
remember that Lord Nelson, the 
hero of Trafalgar, had only one eye 
and an empty sleeve. Not all peg- 
legged, patch-eyed, and Captain 
Hook type pirates were figments of 
imagination. Such people existed, 
and those who came out second best 
in encounters with them took small 
comfort from their altered physical 
states. The wooden ships may have 
passed into history, but there are 
still some iron men about. 

Civil service employees are not 
obliged to retire at any specified 
age. At least one now sailing for the 
MSC is over 70 and is considered an 
especially competent seaman. 

Yet there are times when even 
the highly motivated person is 
physically unable to function safely 
and effectively. At such times, the 
cognizant medical officer should 
find the mariner unfit for duty. With 



rare exceptions, either light or 
limited duty is a practical impossi- 
bility for a crewmember on an MSC 
ship. This is especially true in the 
case of ships engaging in underway 
replenishment operations, where all 
crewmembers lend a hand and 
regularly perform tasks not in- 
cluded in their regular work. 

Since few medical officers have 
had direct experience with MSC 
ships, those who must make the 
decision of fit or unfit for duty can 
benefit greatly by discussion with 
ship officers and by referring to the 
supplemental health record where 
physical requirements are listed (SF 
78) . If it seems unlikely that the civil 
service mariner would be fit for duty 
in time to sail with the ship, the 
master should be informed as soon 
as possible, since the ship is not 
able to leave port until a replace- 
ment is obtained. 

At the time of hiring or rehiring, 
waivers may be granted by the MSC 
when an applicant does not meet 
physical standards. If the applicant 
has a badly needed skill and the 
personnel department is willing to 
accept the additional risk involved, 
a waiver may be granted. Waivers 
are not intended for use in the case 
of acute illness or injury, nor are 
they to be issued by the medical 
department. 

Where a Navy medical facility 
does pre-employment examinations 
on candidates for MSC employ- 
ment, there is interplay between the 
facility and the MSC personnel 
office. In some cases, the examining 
physician may recommend a waiver, 
and the recommendation may have 
a condition attached. For example, 
a waiver of defective vision might 
be recommended provided correc- 
tive lenses are worn. In any case, 
the medical department only recom- 
mends. The personnel office de- 
cides whether to grant a waiver. 

Medical officers examining and 
treating civil service mariners 



where U.S. Public Health Service 
facilities are available can usually 
refer the mariner for further evalua- 
tion or treatment without much dif- 
ficulty. In those parts of the world 
where such facilities are unavail- 
able, the responsible physician 
must make a preliminary diagnosis. 
A further diagnosis then determines 
fitness for duty before sailing time. 
If the mariner is found unfit, a deci- 
sion must be made either to send 
him to a U.S. Public Health Service 
facility or have him medically evac- 
uated. Again, the cognizant Mili- 
tary Sealift Command office or 
agent can be helpful in working out 
details, and may be able to provide 
information that can help determine 
whether the mariner can or should 
be repatriated by commercial trans- 
portation. 

Details of dental care for civil ser- 
vice mariners are addressed in BU- 
MEDINST 6320.52 and its enclo- 
sure, COMSCINST 6000.1. In gen- 
eral, the Navy provides civil service 
mariners only emergency dental 
care. Other dental care is provided 
by the U.S. Public Health Service or 
at the employee's own expense. 
Special arrangements may be made 
to cover a particular situation. 

There's still much more to know 
about "the other MSC." What else 
might it be called upon to do? As in 
the past, the Military Sealift Com- 
mand might operate transports to 
meet the needs of a contingency 
situation. Its ships might again have 
to transport thousands of evacuees 
from trouble spots around the 
globe. You might even find yourself 
working aboard an MSC ship one 
day as part of a team staffing an 
alternative to a dedicated hospital 
ship. In summary, the Military Sea- 
lift Command is an active part of the 
operating forces of the U.S. Navy, 
tasked with providing sealift sup- 
port to the Department of Defense. 
What does that support include? 
Whatever is needed. 



Volume 70, December 1979 



15 



Emotional Disorders of Learning 



CDR Eli Breger, MC, USNR 

"There is nothing so much worth as a mind well in- 
structed." Ecclesiasticus 

There is universal agreement that for a child to deal ef- 
fectively with his environment he must be educated. He 
needs to develop an ability to learn from experience and 
a capacity to deal with symbols of the written and 
spoken language. A child who learns well develops self- 
confidence and provides gratification and reassurance 
to his parents. 

Many children do not learn well and there soon de- 
velops a significant gap in academic achievement be- 
tween what is expected by his parents and teacher and 
what is attained by the child. Successful learning de- 
pends primarily on a child of adequate intellect with a 
normally developed and organized brain and central 
nervous system. A skillful teacher and interesting 
classroom environment enhance success. 

Even with these elements present many children do 
not learn well because of their psychological problems. 
In this essay our focus will be on this area of emotional 
blocks to learning. Underachievement is invariably not 
an isolated finding. It is but one vital symptom clus- 
tered with other expressions of behavioral difficulty. It 
is essential to study the entire child to enable one to 
identify the specific learning problem and develop a 
proper therapeutic plan. Doing this early in his ele- 
mentary school career is vital because personality then 
is still more fluid and capable of change. 

Core of Problem 

Emotional disorders of learning reflect personality 
problems due to disturbances in the child's relationship 
with key figures in his environment. The disturbance 
may be overtly noticeable or of a more subtle nature. 

The educational process is hindered in essentially 
two ways. First, emotional energy is deflected away 
from learning. Second, the child perceives learning as 
threatening and thereby resists dealing with it. In most 
cases several emotional and developmental issues 
merge and overtax the child's adaptive capacity. This is 
often coupled with subtle neurologic and sociologic 
factors. 



Dr. Breger is Chief of the Psychiatry Service at the Naval Hospital 
Beaufort, S.C. 29902. Copyright 1979 Eli Breger, M.D. All rights re- 
served. May be reprinted or reproduced within the Navy for non- 
profit type educational purposes in keeping with the fair use doctrine. 



In spite of the uniqueness of each child's situation it 
is useful for evaluative and treatment purposes to cate- 
gorize. By so doing, several commonly seen clusters 
emerge. A child usually fits prominently into one such 
group, even if not perfectly and entirely. Let us look at 
some of the commonly seen groupings. 

The Normal bat Slowly Maturing Child. Develop- 
ment is essentially normal but proceeds at a slower rate 
reflecting constitutional factors. Motor landmarks 
(sitting, crawling, walking, etc.) develop on schedule 
and there is a relative freeness from emotional dis- 
turbance. The child seems to have been genuinely 
happy during early years but slow in the realm of social 
and emotional development. Test results for school 
readiness tend to be poor. Play orientation is prominent 
yet work is a demand of which he is not yet capable. 
Only time will ready him. Therefore, the child is helped 
by a transitional class which works at a slower rate or 
perhaps by repeating a grade. 

The Unrelated Child. This youngster has never 
formed a deep love tie with his mother and so is unable 
to transfer this bond to the teacher. Without the bond 
no basis exists for a student-teacher relationship which 
would enable him to develop the incentive to learn. This 
child is characterized by emptiness, immaturity, anxi- 
ety in new situations, and preoccupations with pleasant 
and nurturent daydreams. His history reveals gaps in 
infant care resulting from significant problems in the 
stability and security of family life or in the mental 
health of his mother. 

The Primitive Child. He is governed by his instincts 
and has difficulty controlling and diverting unaccept- 
able drives into socially acceptable channels. The child 
appears to be totally pleasure oriented and seeks im- 
mediate gratification. Disorganization is noticed in 
almost everything he does. He functions as a much 
younger child and does not apply himself consistently 
to any work task. He responds to frustration with 
temper tantrums. Such youngsters come from homes 
characterized by permissiveness, disorganization, and 
low levels of expectation. 

The Aggressive or Submissive Child. Both presenta- 
tions are opposite sides of the same coin. Each reflects 
a child who has difficulty dealing with authority. The 
aggressive child appears to drain his energy by fighting 
when he thinks he is under attack. Because of this, his 
relationships are poor. He is unable to accept construc- 
tive criticism and tends to affiliate with other 



16 



U.S. Navy Medicine 



aggressive children. There is a general distrust of 
people and their motives. Overactivity and distractabil- 
ity are clearly seen and further deflect emotional 
energy away from the learning task. The child's home 
environment is characterized by considerable family 
strife providing a model for his own behavior. The 
parents tend to be excessively authoritarian in their 
training and discipline. They demand blind obedience 
for the purpose of attaining dominance. They do not 
help their child to gradually develop a code of accept- 
able social behavior. 

Although the submissive child appears to be very 
much the opposite, he is not. His emotional nature is 
weaker and he has been made afraid by the forces and 
pressures described above. He has constructed a strong 
inhibitory armor beneath which seethes much destruc- 
tive rage. The energy required to control his emotions 
is not available to him for learning. He appears fearful, 
fragile, sensitive, and highly anxious. When pushed to 
the brink, his anger frequently does emerge. At other 
times it escapes in the form of secretive and unsociable 
behavior. 

The Highly Anxious Child. His anxiety may be so 
visibly noticeable that he appears to be "creeping out 
of his skin" from tension. He is overly active and dis- 
tractable. His anxieties reflect a variety of security 
threatening situations which may not be too hard to un- 
cover should one investigate. This apprehension 
seriously interferes with ability to concentrate and 
therefore his facility to learn. Perhaps there is parental 
dissent, separation, illness, or death playing a role 
within the family. 

The anxious youngster also exists whose creative 
potential cannot be harnessed. In his own mind, usually 
on an unconscious level, it seems dangerous to learn. 
Some of the underlying issues appear as follows. He is 
afraid to assume a position of competence because 
more and more will be asked of him. He is afraid to 
commit himself because of the threat of error and criti- 
cism inherent in early learning and the teaching 
process itself. Poor learning may reflect fear that his 
actual ability is not there or that the well will run dry 
should he let himself try too often. On occasion, one 
sees a child whose early learning was coupled with a 
traumatic event, leading him to conclude that knowing 
is dangerous; an example is a child who learned to spell 
dirty words for which he was severely reprimanded. 

The Preoccupied Child. This child's life history in- 
cludes loss of loved ones, defects in maternal nurtur- 
ence, and a general feeling of never having fully experi- 
enced fun and pleasure. Unlike the unrelated child this 
youngster has established primary love ties and there- 
fore is relatively stronger. His daydreams are 



invariably of a play oriented or wish fulfillment nature. 
They may reflect a child who was placed in a nursery 
school or day care center at a too early age and for long 
periods of time. This may have led him to think often of 
how nice it would be to be home with his family. 

Other children may be preoccupied with feelings of 
guilt having to do with unacceptable thoughts of an 
aggressive or sexual nature. This latter issue is often 
present in a passing manner during junior high school 
and may account for the academic slump so commonly 
encountered at that time. 

Advice to Parents 

Corrective efforts should initially focus on the early 
identification of such children with diagnosis of the type 
of emotional block to learning with which we are 
dealing. The family can do a great deal through obser- 
vation and self-analysis. Their efforts should then be 
enlarged to include a school conference and consulta- 
tion with the family physician or pediatrician. Verifica- 
tion of the child's neurologic soundness and general 
good physical health is primary. Particular attention 
should be given to evaluating his vision and hearing 
adequacy. Skillful psychologic testing plays a vital role 
in assessing the child's intellectual ability and ruling 
out any specific, nonemotional learning disability. 

Once we have clarification of the specific nature of 
the emotional block to learning, corrective efforts on 
many levels may be necessary. Most helpful is the cor- 
rection of any imbalance within the family which has 
impaired the child's development of trust and security. 
When we help a child to "learn to love" we go a long 
way toward enabling him to "love to learn." 

As to how much parental involvement in the super- 
vision of his studies is required depends on the nature 
of the child and his parents and the working out of a 
plan with teachers. Generally speaking, the youngster 
should be held responsible for his work. Parents are 
often not the people who can carry this out effectively. 
Backup support of the child's teachers is necessary. 

The classroom situation is important. A skillful and 
experienced educator can be of immense help, particu- 
larly after he or she knows more about the child's prob- 
lem. The teacher's role is primarily and basically to 
teach. With personal and clinical information, the 
educator should be able to improve the quality of the 
relationship with the child, thereby increasing teaching 
effectiveness. For many disturbed children, placement 
becomes necessary in special classes or schools offering 
a more favorable teacher-pupil ratio and more special- 
ized teaching techniques. Quite often, psychotherapy 
for the child with accompanying parental counselling is 
a vital part of the therapeutic plan. 



Volume 70, December 1979 



17 



EDUCATION & TRAINING 



Refresher Training for Submarine 
Hospital Corpsmen: A Working Model 

CAPT B.D. Dutton, MC, USN 



With the useful half-life of medical knowledge often 
estimated as short as five years, there is general agree- 
ment that health workers must pursue a vigorous pro- 
gram of continuing education (refresher training) or 
risk rapid functional obsolescence. Since the absolute 
amount and complexity of medical knowledge are in- 
creasing logarithmically, the program must be as effi- 
cient as possible to remain timely. 

Recognizing this training need, the medical and com- 
mercial education communities have responded with a 
bewildering array of continuing education offerings — 
lectures, journals, seminars in exotic environments, 
films, videotapes, audiotape series, and on and on. 
Many of these offer high quality education, but most 
fall far short of being classified as an optimal continu- 
ing education program. 

Though a full discussion of the subject is impossible 
here, there are a few highly desirable guidelines. An 
optimal continuing education program should be: 

• systematic and pursued according to a specific 
plan. 

• all inclusive and accessible to everyone who needs 
it. 

• task-based to insure that it remains relevant and 
purposeful. 

• comprehensive to cover all areas of need. 

• diagnostic and prescriptive in that it should assist 
workers to determine their weaknesses and be capable 
of correcting them. 

• individualized. 

• capable of producing measurable results. 



Dr. Dutton is director, Operational Medicine Department. HSETC 
Bethesda, Md. 20014. 



Hospital corpsmen who serve aboard submarines 
face the same continuing education needs and obstacles 
as their nonundersea and civilian colleagues. There 
are, however, several constraints presented by the 
undersea environment. For example: 

• Shore assignments for the HM(SS) are often ad- 
ministrative positions. Therefore, maintenance of clini- 
cal skills depends largely on the refresher program. 

• Corpsmen must often report directly from shore 
assignment to their new units instead of via a refresher 
course. Once corpsmen are aboard, due to the high 
tempo of operations and inspection schedules, com- 
manding officers are commonly unable to excuse them 
for training. 

• There is no mandatory requirement for refresher 
training other than at the local level. 

• Areas of submarine concentration do not always 
include an NRMC that could be used for training. 

• The corpsman's communication with support 
medical personnel for consultation is not aways good. 

• All future training must consider the physical and 
psychological environment of the submarine, including 
the AMALs (Authorized Medical Allowance Lists). 

• All future on-board training must be consistent 
with the limited reference material, equipment, and in- 
structional hardware available aboard a submarine. 

Under direction of the Naval Health Sciences Educa- 
tion and Training Command (HSETC), a continuing 
education program has been developed which when 
supplemented by existing programs, both meets these 
guidelines for a high quality training system and recog- 
nizes the constraints of undersea operations. The logic, 
methodology, and many of the instructional materials 
of the system are readily adaptable for use in other 
medical settings. Development was in accordance with 



is 



U.S. Navy Medicine 



standard instructional design procedures in NAVED- 
TRA 106-A. 

Training Needs 

Experts from the submarine community and educa- 
tion staff at HSETC identified training needs in the 
cognitive (pertaining to knowledge of facts and figures) 
and psychomotor (the ability to perform manual skills) 
domain. None in the affective (pertaining to attitudes 
and motivations) domain were thought necessary for in- 
clusion in the program. There was unanimous agree- 
ment that the program should emphasize clinical skills; 
there are already suitable mechanisms for training in 
administration. Requirements fell into the following 
categories: 

• History and physical; general data collection 

• Problem-solving as applied to diagnosis and 
patient management 

• Laboratory procedures 

• Clinical features of specified conditions and dis- 
eases 

• Manual skills 

A complete outline of the refresher program content 
is available from HSETC. 

Training Strategy 

The goal is that all submarine hospital corpsmen 
going to or actually on operational assignment partici- 
pate in the formal continuing education program, with 
recertification of competence in specified clinical skills 
every 18 to 24 months. All corpsmen holding NEC 8402, 
even if assigned ashore, are encouraged to participate. 

The principle of the training system is that the corps- 
man meets defined training objectives by participation 
in one or more of a variety of formal and informal train- 
ing experiences which are carefully oriented toward the 
objectives. Current certification may be evidenced by a 
qualification card listing the required clinical areas and 
practical skills, with competence validated by a medical 
officer or an appointed representative, such as a physi- 
cian's assistant or a laboratory technician. Training will 
be conducted aboard the submarine and in an NRMC. 

Training Methodology 

For clinical experience to be meaningful, students 
must have an adequate academic base of knowledge 
and skills. Ideally they should have this base before 
participating in a clinical course. To this end a recom- 
mended program of independent study aboard the sub- 
marine is being prepared. The study materials are 
subject-based and cover the previously identified re- 



quired areas. This includes textbooks, journal articles, 
films, and other types of educational material. Most 
important, following a detailed study guide and 
schedule will assure coverage of all subject areas within 
a one-year period. Also important is a list of criterion- 
referenced objectives* (all of which are covered by the 
materials) based on previously determined job require- 
ments. All materials will be available from the squad- 
ron medical office. 

This plan aims at maintaining corpsmen who can do 
their job well (criterion-referenced objectives); it also 
encourages those who desire and are capable of an en- 
richment program (subject-based materials and study 
guide).** 

At NRMCs in areas of high submarine concentration, 
the goal is to establish a two-week, clinically oriented, 
formal training program. The course has specific clini- 
cal objectives and is highly experiential in nature, 
oriented around a series of clinical rotations, with just 
sufficient didactic opportunity to integrate the experi- 
ences. Teaching modalities include: 

• Case study 

• Teaching ward rounds (using selected patients) 

• Observing and participating in patient care in such 
areas as the OPDs, ERs 

• Supervised practice in specified clinical procedures 

• Teaching conferences 

• Clinical rotations and evening duty 

• Clinical simulation, such as models, mannequins, 
simulated patients, and computerized instruction 

If corpsmen complete the recommended program of 
independent study at their duty station, there will be 
little need for basic study at the NRMC. In this case, 
they may devote essentially full time to clinical matters; 
however, this may not be possible. Furthermore, not all 
the recommended clinical content can be covered in a 
two-week period, or the desired clinical material may 
not be available. Therefore, to define more exactly the 
academic base, upon reporting to the course, each 
trainee will take a diagnostic pretest covering the de- 
sired clinical content. This will point out items for 
emphasis and areas of competence that can safely be 
omitted. 



♦The criterion-referenced system is a no-frills approach to educa- 
tion in which specific skills are taught and limited objectives sought. 
A student, for example, must recognize a disease's specific symp- 
toms or learn to use a medical instrument. 

**The subject-based concept allows the student to go beyond the 
essentials and study the subject more intensively. This might mean 
the general study of. for example, physiology. 



Volume 70, December 1979 



19 



At the course site, six self-paced teaching modules 
for supervised self- study and specifically oriented 
toward independent duty submarine medical practice 
will be available for trainee use. They cover respec- 
tively: History and Physical Examination, Abdominal 
Conditions, Chest Conditions, Neurologic and Psychiat- 
ric Disorders, Genitourinary Conditions, and Dental 
Conditions. Their purpose is correction of academic 
deficiency, partial substitution for unavailable clinical 
material, or general review. Each module is in the 
format of the Personalized System of Instruction (PSI) 
advocated by Dr. Fred Keller of Georgetown Univer- 
sity. Designated hospital personnel will serve as 
proctors for each module. PSI is ideally suited for this 
training. It has the specific advantages of conserving 
faculty time, yet is flexible enough to readily accom- 



modate irregular and varying student schedules and 
abilities. During the two-week period, corpsmen will go 
through as many of these modules as indicated by their 
pretest, or as they desire, or have the time for. 

Implementation 

Instructional materials are now being developed, and 
on a limited basis, the clinical training has been insti- 
tuted at NRMC/Naval School of Health Sciences, Ports- 
mouth, Va. Initial reaction to the course has been 
strongly positive. A continuing education system such 
as this, which is based on proven principles of learning 
and offered in a manner well accepted by students, 
should go a long way toward maintaining the high level 
of competence expected of Medical Department per- 
sonnel. 



Professor Lambertsen Awarded Mark 5 Helmet 



At the 1979 annual meeting of 
the Undersea Medical Society in 
Key Biscayne, Fla., 13 Navy 
diving medical officers presented 
a brightly burnished Navy diving 
helmet to Professor Christian J. 
Lambertsen, M.D. for the Insti- 
tute for Environmental Medicine 
in Philadelphia. The Institute, 
founded by Lambertsen, is part 
of the University of Pennsylvania 
Medical Center. Its research and 
training programs utilize a very 
sophisticated high pressure 
chamber facility capable of simu- 
lating human dives to as deep as 
2,000 feet of seawater. Since 
1959, through an agreement be- 
tween Lambertsen and the 
Navy's Bureau of Medicine and 
Surgery, Medical Department of- 
ficers have received extensive 
postgraduate training in diving 
physiology at the university. The 
training program was established 
by the Navy to accelerate direct 
human working access to con- 
tinental shelf and slope depths. 
In a plaque attached to the 



helmet, the 13 former students, 
ranking from LCDR to CAPT, 
thanked Lambertsen for the qual- 
ity of his training program and 
for his long-term influence on 
Navy diving. In accepting, 
Lambertsen called attention to 
what he called the formidable re- 
search accomplishments and ex- 
ceptional scientific leadership of 
the Navy diving medical officers 
themselves. He then emphasized 
the extensive international gains 
that have resulted from individ- 
ual research by naval or civilian 
scientists and urged that the op- 
portunity for naval biomedical 
research training in the univer- 
sity be actively continued. He 
cited the critical importance of 
mutual support by federal, uni- 
versity, and industrial organiza- 
tions having interests in under- 
sea work of many forms. He 
promised continued efforts by 
the Institute for Environmental 
Medicine to increase the scope 
and safety of diving and related 
undersea activities. 



The award itself is a classic 
Navy Mark 5 deep sea diving hel- 
met which has been in continu- 
ous diving use since its manu- 
facture in 1942. During World 
War II it had been part of the 
equipment of a salvage team 
operating in Guam. A fixture of 
Navy diving for over 60 years, 
the copper Mark 5 helmet may 
soon become a working relic like 
the DC-3 when the Navy intro- 
duces its replacement, the mod- 
ern design fiberglass Mark 12 
helmet into the fleet. 

Lambertsen and the Institute 
staff were also recognized by the 
Aerospace Medical Association 
in its 1979 annual meeting in 
Washington, D.C. The Environ- 
mental Science Award was 
awarded to Lambertsen for the 
research study entitled "Human 
Tolerance to He, Ne, and N2 at 
Respiratory Gas Densities Equiv- 
alent to He-02 Breathing at 
Depths to 1,200, 2,000, 3,000, 
4,000 and 5,000 Feet of Sea 
Water (Predictive Studies III)." 



U.S. Navy Medicine 



NOTES & ANNOUNCEMENTS 



MSC TRAINING COURSES AVAILABLE 



The Army and Air Force courses listed below are 
open for Navy Medical Service Corps and Medical 
Corps officers of the appropriate specialties. Applica- 
tions must be submitted in accordance with BUMED- 
INST 4651. IB and received at the Naval Health 
Sciences Education and Training Command at least six 
weeks before the course date to assure availability of 
the limited quotas. 

For further information, contact; LT D.M. McGann, 
MSC, USN, Director, Medical Service Corps Programs, 
Naval Health Sciences Education and Training Com- 
mand (Code 6), National Naval Medical Center, 
Bethesda, Md. 20014. Telephone: Autovon 295-0624, 
Commercial (202) 295-0624. 

ARMY COURSES 

Army Podiatry Seminar 
Walter Reed AMC 
Washington. D.C. 
25-28 Feb 1980 

Laser- Microwave Hazards Workshop 
USA Environmental Hygiene Agency 
Aberdeen Proving Grounds, Md. 
16-21 March 1980 

Nuclear Pharmacy Orientation 
Letterraan AMC 
San Francisco, Calif. 
16-28 March 1980 

Administration for Hospital Food Service 

Academy of Health Sciences 

U.S. Army 

Fort Sam Houston, Tex. 

30 March -4 April 1980 

Health Care Administration Executive Symposium 

Academy of Health Sciences 

U.S. Army 

Fort Sam Houston, Tex. 

6-11 April 1980 

Health Care Logistic Management 
Fitzsimmons AMC 
Aurora, Colo. 
6-11 April 1980 

Musculoskeletal Assessments for Physical Therapy Officers 

Academy of Health Sciences 

U.S. Army 

Fort Sam Houston, Tex. 

6-18 April 1980 



Pathology and Laboratory Symposium 
Walter Reed AMC 
Washington, D.C. 
20-25 April 1980 

Army Pharmaceutical Service Management 
Walter Reed AMC 
Washington, D.C. 
18-23 May 1980 

Occupational Health Workshop 
USA Environmental Hygiene Agency 
Aberdeen Proving Grounds. Md. 
1-6 June 1980 

Military Optometry 
Fitzsimmons AMC 
Aurora, Colo. 
14-19 Sept 1980 

AIR FORCE COURSES 



Medical Aspects of Advanced Warfare {0-4 and above. 

SECRET Clearance) 
Brooks AFB, Tex. 
28 Jan-1 Feb 1980 

Laser Hazard Assessment 
Brooks AFB, Tex. 
4-8 Feb 1980 

Industrial Hygiene Measurements 

Brooks AFB, Tex. 

13-27 Feb 1980. 2-13 June 1980, 14-25 July 1980 

Physical Therapy {Advanced) 
Wilford Hall USAF Medical Center 
San Antonio, Tex. 
3-21 March 1980 

Medical Food Service Management for Dieticians 
Brooks AFB, Tex. 
21-25 April 1980 

Physical and Occupational Therapy Management 
Wilford Hall USAF Medical Center 
San Antonio, Tex. 
28 April-2 May 1980 

Pharmacy Seminar 
Brooks AFB, Tex. 
20-22 May 1980 

Behavioral Sciences Symposium 
Brooks AFB. Tex. 
28-30 May 1980 

Operational Problems with Aerospace Physiology 
Brooks AFB, Tex. 

2-6 June 1980 



Volume 70, December 1979 



21 



PROFESSIONAL 



A Podiatric Blunt Dissection Technique 
for Plantar Wart Removal 

LT Ronald A. Warcholak, MSC, USN 



Recently, medical literature articles have appeared pro- 
claiming the advantages of blunt dissection of plantar 
warts or verrucae. It is the purpose of this paper to 
present a podiatric office technique that I have used for 
over 10 years and to show how it is particularly suited to 
the feet of active duty military personnel. Because 
healing results in no scar formation, blunt dissection is 
ideally suited to the sole of the foot. 

Diagnosis 

It is extremely important to make an accurate diag- 
nosis of a plantar wart as there are several lesions ap- 
pearing on the plantar surface of the foot which resem- 
ble warts. The intractable plantar keratoma (IPK) is the 
most common lesion which resembles a wart on the sole 
of the foot. These lesions are the result of excessive 
weight-bearing on a plantar displaced metatarsal head. 
All attempts to eradicate these IPKs, as they are com- 
monly called, utilizing wart therapy will prove futile. 
IPKs are the result of a biomechanical disturbance 
while warts have a viral etiology. 

Porokeratotic lesions are another entity found on the 
sole of the foot, especially the heel, which are often mis- 
diagnosed as plantar warts. These lesions are simply 
referred to as plugged sweat glands as this name ac- 
curately describes them. They resemble small plugs of 
hyperkeratotic tissue surrounded by a whitish rim. 
Porokeratotic lesions are found over weight-bearing 
areas of the foot and can be extremely painful when the 
patient is ambulating. (/) 

Seed corns or heloma miliare are another dermatolo- 
gical entity found on the plantar surface of the foot. 
They may at times be confused with small plantar 



LT Warcholak is the podiatrist at NRMC Camp Lejeune, N.C. 
28542. 



warts. Heloma milliare are usually very tiny, clear in 
character, and resemble small seeds of callous tissue. 
They are often found embedded in a hyperkeratotic 
depression on the sole of the foot. Often they may be 
quite numerous and give the sensation to the patient of 
walking on particles of sand, (2) 

One may reasonably diagnose a plantar wart if the 
following criteria are met: 

• Plantar warts tend not to be found over bony 
prominences, metatarsal heads in particular. Warts are 
caused by viral invasion and are not the result of exces- 
sive pressure or a biomechanical abnormality. If a simi- 
lar lesion appears in exactly the same location on both 
feet, it is more reasonable to diagnose a biomechanical 
problem than a plantar wart. 

• Plantar warts are very vascular and consequently 
bleed very easily when cut. The common misconception 
that warts have seeds is erroneous. What appears to be 
tiny black seeds are actually tiny capillaries. Take a 
scalpel blade and remove the superficial skin covering 
the wart and you will see small bleeding points coming 
from the cut capillary tips. This is an accurate indica- 
tion that the lesion is most probably a wart. (Figure 1) 

• Plantar warts are more painful when squeezed. 
Intractable plantar keratomas (IPKs) are more painful 
when direct finger pressure is applied to them. 

• Plantar warts have a distinct line of demarcation 
from the surrounding healthy tissue in which they are 
imbedded. The capillary tips are located in the center 
and are perpendicular to the skin. The IPKs and seed 
corns will have the normal papillary skin lines running 
parallel across their crystalline hyperkeratotic centers. 

Blunt Dissection Technique 

The technique is simple and one can become quite 
I adept at it with just a little practice. Remember, stay in 



22 



U.S. Navy Medicine 




FIGURE 2 

the skin layer. Do not penetrate into the fatty tissue. 
This is the essence of the technique. 

1. Infiltrate about the wart with a local anesthetic. 
We routinely use 2 percent Lidocaine ( Xylocaine® ) 
with 1:100,000 Epinephrine. However, any local anes- 
thetic may be used even without the use of a vasocon- 
strictor. For safety, if a wart is located on a toe, the digit 
should be blocked without the use of a vasoconstrictor. 
A small tourniquet can be placed about the toe to 
achieve hemostasis if so desired. It is, of course, 
removed after the wart is removed. 

2. Scrub the foot with a surgical soap and paint with 
an antiseptic. Five sterile instruments are used — a No. 
150 tissue forceps with convex jaws, a No. 51 soft corn 
spoon, a No. 4714 size 2 bone currette, a thumb 
forceps, and a scalpel with a No. 10 blade. 



FIGURE 4 

3. Use a scalpel handle fitted with a No. 10 blade to 
remove the superficial covering of the wart. Often the 
wart will appear larger than was originally thought. The 
outline of the wart should now be quite clearly deline- 
ated. (Figure 2) 

4. A curved tissue nipper is now used to make a 
small nick on the periphery of the wart so that the in- 
strument can be inserted at the outermost edge of the 
wart. (Figure 3) 

5. Take the soft corn excavator and insert it into the 
nick at the periphery of the wart. Begin now to separate 
the wart from the surrounding tissue. A drawing, 
pulling action is used much like trying to separate a 
raisin from a slice of raisin bread. Be careful to stay in 
the skin layer. Do not puncture the deeper fascial layer 
because scarring will occur. If care is used, one should 
see the white tissue of the wart capsule which separates 



Volume TO, December 1979 



23 



the bottom of the wart from the deeper tissues. Very 
little bleeding should result from this dissection 
whether or not a vasoconstrictor was used in the local 
anesthetic. 

6. Bluntly dissect the wart away from the surround- 
ing tissue as thoroughly as possible. Now cut the wart 
away from the small skin tab which may still bind the 
wart if it remains attached. {Figures 4 and 5) 

7. With the small bone currette, scrap the resulting 
concavity clean of all verrucous tissue. (Figure 6) 

8. With the curved tissue nipper cut or bevel the 
edge of the concavity. This will allow for smooth filling 
of the wart with granulation tissue. 

9. Place an antibiotic cream inside the wound. Apply 
a nonadherent pad over the wound cavity. This is fol- 
lowed by a bulky dry sterile dressing. The patient 
should be advised that some bleeding may later be 




FIGURE 5 




FIGURE 6 








FIGURE 7 




FIGURE 9 



24 



U.S. Navy Medicine 



noted on the bandage but that this is no cause for 
alarm. (Figures 7-9) 

Conclusion 

There is virtually no postoperative pain and most pa- 
tients require no analgesic medication. Those that do, 
however, Find relief with mild nonnarcotic analgesic. 

Postoperative infection with this technique is virtual- 
ly nonexistent. The absence of post-surgical infection 
may be due to the small amount of cleansing hem- 
morhage from the wound the first few hours after exci- 
sion. 

Healing time is very rapid, averaging from 8 to 10 
days. We see the patient three times, postoperatively, 
usually on the fourth, tenth, and fourteenth day. Most 
military personnel can be returned to full duty on or 
about the tenth postoperative day. 

This procedure can easily be accomplished in the 



doctor's office in approximately 20 minutes. To facili- 
tate the procedure, we keep sterilized wart instrument 
kits available at all times. 

Although I did not originate this technique, I have 
used it on countless Navy and Marine personnel at 
Camp Lejeune, N.C., and have experienced no diffi- 
culties whatever. I believe, wholeheartedly, that this is 
the procedure of choice for surgical removal of plantar 
warts, as healing occurs without painful scar formation 
on the sole of the foot. 

Statistics are unavailable but the reoccurrence rate 
appears to be minimal. 

References 

1 . Yale I: Podiatric Medicine. Baltimore, Williams & Wilkins Co, 
1974. pp 122-123. 

2. Charlesworth F: Chiropdy. Theory and Practice, ed 5. London, 
Actinic Press, Ltd, 1961, p 38. 



Simple Solution to a Chronic Problem 



Often by the time a pharmacy 
receives mannitol injection 25 
percent, crystallization has al- 
ready occurred in the ampule. 
This presents the hospital phar- 
macist with a small problem. One 
can follow directions from the 
manufacturer and make a hot 
water bath(/) in which to im- 
merse the ampules and then 
store them on the shelf only to 
find that the solution has again 
precipitated. 

There is a simple solution to 
this common problem. Methodist 
Hospital in Memphis, Tenn,, 
uses a styrofoam cooler with a 
low wattage incandescent bulb to 
store and keep mannitol injection 
25 percent from crystallizing. 

Shortly after coming to NNMC 
Bethesda, Md., I obtained a 
small cooler (16 x 10 x 9 inches) 



and had a 15 watt bulb installed. 
The cooler maintains a constant 
temperature of 35°C. Using the 
manufacturer's suggested 
method as stated in the package 
insert, the solution must be 
allowed to cool to body tempera- 
ture prior to use. The cooler tem- 
perature is already very close to 
body temperature, thereby sav- 
ing considerable time in prepar- 
ing the ampules for use. 

One other method used to re- 
dissolve mannitol is autoclaving. 
I mention this to show that the 
temperature I advocate will in no 
way harm the solution. A study 
was undertaken in 1975 by Muty 
and Kapoor to determine the ef- 
fects of repeated autoclavings on 
mannitol. (2) They used tempera- 
tures at 250°F for 15 minutes and 
subjected each ampule at least 



this 
now 

"Hot 



five times. They found no pres- 
ence of particles from the rubber 
stoppers and no change in chemi- 
cal or physical properties of the 
solution. 

We have been using 
method for three months 
and have had no problems. 

The total cost of the 
Box" is about $10. We are now 
considering placing one "Hot 
Box" on each nursing station. 

References 

1. Mannitol Injection, Merck, Sharp 
and Dohme, Package insert, March 1976. 

2. Murty R, Kapoor JN: Properties of 
Mannitol Injection (25%) After Repeated 
Autoclavings. Am J Hasp Pharm 32:826- 
827, Aug 1975. 

— LTJG Charles F. Hostettler, MSC. 
USNR, Pharmacy Staff, NNMC Bethesda. 
Md. 



Volume 70. December 1979 



25 



Occupational Lung Disease 



CAPT T.V. McManamon, MC, USN 



The human pulmonary biosystem has apparently 
adapted very well to the terrestrial atmospheric en- 
vironment of the earth over the past 4 million years. 
Beginning with the industrial revolution, there has 
been a logarithmic escalation of atmospheric pollution. 
The various life forms on this planet are now having to 
pay the price for previous industrial progress. 

Even though they are anatomically interior ized and 
uniquely protected by the thoracic cage and guarded by 
efficient defense mechanisms such as the mucociliary 
escalator, the human lungs are the main interface be- 
tween the human biosystem and the occupational 
environment. Atmospheric contaminants such as infec- 
tious, toxic, carcinogenic, and sensitizing agents cause 
most of the occupational pulmonary diseases. To be 
able to evoke a pathological pulmonary response, these 
contaminants must be able to bypass the various de- 
fense mechanisms of the tracheobronchial tree and be 
able to reach the lower respiratory tract. The specific 
toxin must then be deposited or absorbed on various 
bronchial or alveolar surfaces. In addition to deposition, 
there must be sufficient residual time for the toxin to be 
in contact with the alveolar surface for it to elicit a path- 
ological response. Although the pathological response 
can be very prompt, it more characteristically takes 
years or even decades for an atmospheric toxin to pro- 
voke a recognizable clinical syndrome. Similar to other 
human organ systems, the tissues of the respiratory 
tract can react to multiple insults with only a limited 
number of responses. Many harmful pulmonary agents 
can produce a biphasic pathological result, including an 
acute response that may be clinically manifested for up 
to 24 hours after the initial exposure and a chronic ef- 
fect that may be delayed for months or years. 

There is an increasing accumulation of evidence sug- 
gesting that many occupational lung diseases are mani- 
festations of adverse immunological mechanisms. 
Characteristics of the end stages of beryllium, 
asbestos, and progressive massive fibrosis of coal 
workers pneumoconioses are consistent with delayed 
hypersensitivity type of immunological mechanisms. It 
is also of interest that many young adult female pa- 
tients with chronic beryllium disease began their fatal 
clinical course only after the onset of their pregnancies, 



From the Environmental Health Service and Clinical Investigation 
Center, NRMC San Diego, Calif. Supported in part by BUMED Clini- 
cal Investigation Program. 



which in many ways represents a temporary, partial 
immunosuppressive state. 

The occurrence of many occupationally related bron- 
chogenic carcinomas seems to correlate well with the 
patient's age and decreased levels of immune effi- 
ciency. Even though some authorities feel that the in- 
creasing incidence of lung cancer (78,000 lung cancer 
deaths in 1977) appears to be the result of increasing 
atmospheric pollution in our environment, a more 
factual analysis of the data would incriminate cigarette 
smoking as the primary etiological agent. Also, the 
anticipated or predicted increase in case loads of other 
forms of specific occupational lung diseases in the 
general working population is not appearing at this 
time. Certainly, in industrial communities that are 
economically dependent on a specific hazardous 
material such as asbestos, uranium ore, and coal, the 
incidence of recognizable pulmonary pathology can be 
higher than in a comparable population group. 

The employed military and civilian populations in the 
United States are very mobile groups, both geographi- 
cally and employmentwise. Exposure to occupational 
pulmonary hazards for even those individuals who 
remain with a single employer for a sufficient period of 
time to eventually qualify for retirement benefits can be 
extremely variable. Under one employer, many workers 
change job exposures frequently as new products or 
processes are developed, as new plants are built, or as 
old plants are modified and changes in plant ventilation 
or layout occur. As a result of these alterations, a spe- 
cific worker can be exposed to varying concentrations 
and types of atmospheric contaminants during his 
working years. As an example, a manufacturer may 
sequentially utilize asbestos fibers, then at a later date, 
switch to fiberglass fibers, and eventually a plastic 
polymer substitute, while producing what appears to 
the consumer to be the same end product. 

Because freedom and fluidity of occupational career 
patterns are evident in the United States, many individ- 
uals who are adversely affected by one or more deleteri- 
ous aspects of a work environment often voluntarily 
drop out of that particular worker population. The in- 
dividual worker may decide to quit a job because he 
does not like the smell or dust, or because he feels 
"choked up" whenever he works. These workers flow 
to more compatible occupational environments, leaving 
those who are not bothered by these factors or who are 
willing to tolerate them for other reasons. In this latter 
group of long-term employees, the highest incidence of 
occupational lung disease should be found. However, in 



26 



U.S. Navy Medicine 



those employees who persist in work situations with 
hazardous agents, many may be genetically endowed to 
resist the adverse respiratory effects of the individual 
or combined toxic materials. This tolerance to the 
deleterious effects of particular hazardous agents per- 
mits them to retire unscathed as "surviving veterans." 
They should not be considered as truly representa- 
tive of the total exposed population. Thus, the old Chief 
Petty Officer who states, "I have been working with 
asbestos for 20 years and it hasn't hurt me a bit," may 
be speaking factually for himself but not necessarily for 
many other less fortunate naval personnel. 

The approximately 70 square meters of alveolar sur- 
face is roughly equivalent to the area of a tennis court. 
Affecting this extensive surface are those atmospheric 
contents that evade all of the various, marvelous 
defense mechanisms of the respiratory system. Most 
occupational pulmonary hazards can produce clinical 
manifestations after a long latent period as in the case 
with asbestos. Most individuals continuously exposed 
to high concentrations of respirable asbestos dust 
usually do not demonstrate any recognizable pulmonary 
abnormality symptomatically or on physical examina- 
tion before seven years after initial exposure. Clinical- 
ly, the interstitial pulmonary fibrosis of asbestos is not 
different from that of other causes and does not gen- 
erally manifest itself until 10 to 15 years after initial 
exposure. The latent period of invasive malignant 
mesothelioma secondary to asbestos exposure may be 
up to 30 or even 40 years following initial exposure. 
Obviously, some workers prone to develop mesothe- 
lioma die from other causes before the mesothelioma 
appears. Similarly, asbestosis related bronchogenic 
carcinomas may take eight years before the initial 
roentenographic or cytologic manifestations are recog- 
nizable by the clinician. There are some indications that 
cigarette smoking, in addition to perhaps acting as a 
carcinogen for various occupationally related bron- 
chogenic carcinomas, may actively shorten the usual 
latent periods for some of the occupationally induced 
pulmonary interstitial fibroses (e.g., beryllium), 

Many occupational toxins interfere with basic 
enzymatic biosystems such as heavy-metal poisoning of 
sulfhydril groups which can initially produce diffuse 
and nonspecific biological effects. These effects usually 
are not evident to the patient or clinically identifiable by 
the physician until sufficient distortion of the patient's 
biosystem has resulted. Frequently, it is the epidemio- 
logic aspects of occupational lung disease that force us 
to recognize its existence. Our current level of diag- 
nostic sensitivity may not be sophisticated enough to 
recognize a pulmonary occupational poisoning very 
early in its clinical course. Similarly, an employee with 



nonspecific changes on his annual chest x-ray or pul- 
monary function test can have these changes tempo- 
rarily explained by aging, smoking, or other factors so 
that the underlying occupational toxin remains uniden- 
tified for a considerable period of time. 

Each employee ventilates a theoretical tidal volume 
of 250 cc per breath which equates to four liters per 
minute or 2 million cc of air per eight-hour shift. The 
allowable concentration of asbestos by the current 
OSHA standard is two asbestos fibers per cc of respira- 
ble air. Therefore, at the present time, all employees 
are permitted to inhale approximately 4 million cc 
asbestos fibers greater than 5 mm in length each work- 
ing day. Because of the inherent structural characteris- 
tics of many naval vessels, the respiratory tract of 
embarked naval personnel can be exposed to various 
atmospheric contaminants such as asbestos dust on a 
24-hour basis in contrast to the usual eight-hour expo- 
sure of shore-based facilities. Such factors deserve 
serious consideration in the medical evaluation of 
embarked naval personnel and especially in the design 
of future naval vessels. For all practical purposes, the 
permitted exposure to asbestos dust is being reduced to 
0.5 fiber per cc of respirable air. Also, the number of 
asbestos fibers that reach the alveolar surface is ex- 
tremely variable. 

The alveolar surfaces are in the main portal of entry 
for airborne substances both beneficial as well as detri- 
mental. Many toxins are able to affect other organ sys- 
tems after their absorption via the alveolar surface into 
the main circulation of blood. Some of these agents are 
carcinogenic for the lung or other organ systems; some 
toxins are teratogenic during the organogenesis stages 
of the undetected fetus. All may occur in the work en- 
vironment of employed pregnant females. Of greater 
significance are those substances that carry the poten- 
tial to be mutagenic because they will not manifest their 
adverse effects for several generations, will affect both 
sexes, and will not be identified until damage is done to 
succeeding generations. 

Occupational lung diseases are unique in that they 
are all man-made diseases. They are, therefore, all pre- 
ventable. In those industrial settings where adequate 
engineering or industrial hygiene precautions have 
been implemented, there has been a dramatic and 
documentable decline in occupational lung diseases. 
Since it takes so long to clinically recognize occupa- 
tional lung diseases and there is very little we can do 
therapeutically for victims, the only acceptable ap- 
proach is to prevent them in an effort to permit current 
and future generations to live out their normal life 
expectancy free from the man-made hazards of occu- 
pational atmospheric contaminants. 



Volume 70, December 1979 



27 



BUMED SITREP 



EFFECTIVE DATES ON VARIABLE INCENTIVE PAY 
(VIP) CONTRACTS 

Four dates appear on the Variable Incentive Pay 
(VIP) Contract (NAVMED 7220/3 (7-77) NAVCOMPT 
Form 2259 (7-77)) above contract: (1) Date of Eligibility 
— Section B of the Form which is filled in by the Bureau 
of Medicine and Surgery; (2) Date of Acceptance — Sec- 
tion C of the Form which is the date the officer signs 
and dates the contract; (3) Effective Date — Section D of 
the Form which is filled in by the administrative/ per- 
sonnel office and is either the eligibility date or the ac- 
ceptance date; and (4) Date of the Commanding Offi- 
cer's Signature — Section D of the Form which is the 
date the commanding officer (or designated representa- 
tive) signs the contract. The effective date for the Vari- 
able Incentive Pay is the eligibility date, or the ac- 
ceptance date (if that date is more than 30 days sub- 
sequent to the eligibility date). The effective date is 
very important because it determines the year in which 
the VIP income is earned and the tax withholding is 
reported on the W-2. Problems have occurred because: 
(1) medical officers have signed a contract which 
created an acceptance date in. one year and then 
presented the contract to the disbursing officer for pay- 
ment in another year (usually the reason given for this 
is that the commanding officer wasn't available to sign 
the contract until the later date or that the officer con- 
cerned did not desire to be taxed in the year he signed 
the acceptance); and (2) the eligibility date was late in 
the year and the acceptance date was early in the next 
year, but since there were less than 30 days between 
the two dates, the earlier eligibility date became the 
effective date. The result of both of these situations is 
that the VIP payment is included in the officer's earned 
income and tax withheld for the year of the effective 
date vice the year the payment is made to the officer. 
The Judge Advocate General of the Navy has consis- 
tently ruled the money is available to the officer on the 
effective date. Recognizing that the medical officer may 
not be able to obtain his commanding officer's signa- 
ture on the document the same day he signs his accept- 
ance of the contract, procedures which required this are 
being revised to insure that an administrative/person- 
nel officer or other person authorized to sign pay- 
related documents signs the document either the same 
day as the member signs the contract or at least within 
the same fiscal year as the effective date. Medical offi- 



cers accepting contracts in October, November, or 
December will be taxed in that year even if they do not 
present the document to the disbursing officer for pay- 
ment until the following year. Also, for any contracts 
accepted in January, when such acceptance date is less 
than 30 days from an eligibility date in December, the 
officer will be taxed in the prior year because it is the 
year of the effective date. Medical officers who plan to 
negotiate a contract during the last few months of a 
year or at the beginning of a year should seek advice 
from their disbursing officer on how this action will 
affect their tax liability. If an officer does not desire to 
be taxed in a certain year, then he/she should delay 
his/her signing of the acceptance of the contract for a 
period of time which insures that the income and tax 
will be reported in the following year. Also, once the 
effective date is established, this date becomes the be- 
ginning date of the active duty agreement (VIP Con- 
tract) as well as the anniversary date for future install- 
ments of VIP. If an officer fails to complete the total 
number of years of active duty specified in the agree- 
ment (VIP Contract) for any of the reasons listed in 
paragraph 10526 of the DODPM, recoupment of ap- 
propriate portion of the variable incentive pay will be 
required. 



U.S. ARMYBAYLOR UNIVERSITY GRADUATE 
PROGRAM ADMISSION AVAILABLE TO NAVY 
NURSE CORPS 

Navy Nurse Corps officers are now invited to apply 
for the U.S. Army-Baylor University Graduate Program 
in Health Care Administration. This program leads to a 
Master of Health Administration degree. 

Prerequisites include a composite GRE score of 
1,000 and prior completion of courses in economics, 
accounting, and/or finance and statistics. Reference 
BUMEDINST 1520.14E for guidance. Applications 
must be in HSETC (Code 7) no later than 15 Feb 1979 
for consideration for the Fall 1980 class. 

The program brochure is available from: Director, 
U.S. Army-Baylor University Graduate Program in 
Health Care Administration, Academy of Health 
Sciences, U.S. Army, Fort Sam Houston, Texas 78234. 

For further information contact CDR F.C. McKown, 
NC, USN, Autovon 295-0630. 



28 



U.S. Navy Medicine 



INDEX: Vol. 70, No. 1-12, January-December 1979 



ABBOTT, M.O., CDR, MC, USN, MSC: 
not always Medical Service Corps 
— sometimes it's Military Sealift 
Command 12:12 
Abortion, Therapeutic, emotional prob- 
lems after 4:23 
ACDUTRA (active duty for training) 
option: orientation at sea 1:9 
physical exam before 6:7 
Agent Orange update 11:29 
Alcoholism 
BUMED rehabilitation instruction 8:8 
CHAMPUS benefits for treatment of 

6:8 
indoctrination course 1:6 
Navy alcohol safety action program 

5:5 
screening of 6:26 
Alexander, R.E., CDR, DC, USN 
a prevention-oriented approach to 

dental office emergencies 10:16 
San Diego dental officers CPR certi- 
fied 6:4 
American Board Certifications (see 

Certifications) 
American College of Hospital Adminis- 
trators (ACHA) admits new MSC 
members 1:20, 12:10 
Antarctica, Navy in 12:8 
Anxiety attacks 9:22 
Armed Forces Health Professions 
Scholarship Program (AFHPSP) 
information assistance for 6:6 
student air travel within CONUS 
10:27 
Arentzen, W.P., VADM, MC, USN 
a measure of our readiness 12:1 
conference for commanding officers 

2:2 
continuing education for the Navy 

Medical Department 5:1 
cost containment is a personal re- 
sponsibility 2:1 
honored by American Medical Society 

on Alcoholism 5:29 
Naval Reserve: a vital part of the 

Total Force concept 8:1 
Navy committed to quality health care 
9:1, 10:1 



NOTE: Figures indicate the issue and page 
in Volume 70 of U.S. Navy Medicine. For 
example, 12:12 indicates that the article may 
be found in Volume 70, No. 12, page 12. 



productivity 7:1 

prospective commanding officers 6: 1 

public affairs — an all hands evolution 

4:1 
research — the key to our future 1:1 
role of occupational medicine: every- 
one's concern 11:1 
SAC XI: keynote address 11:6 
the impaired professional 3:1 
Arthur, D.C., LT, MC, USN, U.S. Navy 
cold weather medicine training 
course: a challenge met 8:10 
Asbestos 

pulmonary function testing in Navy 

medical monitoring program 6:22 
related diseases 5:18 
roentgenographs findings of asbes- 
tos exposure 5:20 
sampling for airborne asbestos fibers 

5:24 
talc poudrage 11:29 
Associateships, postdoctoral 11:27 
Association of Military Surgeons of the 
U.S. (AMSUS), memberships 10:28 
Astronaut, CAPT J. P. Kerwin, MC, 

USN 12:2 
Audiology 
aural rehabilitation 1:13 
hearing loss among selected Navy 
enlisted personnel 10:21 
Audiovisual aids 
videotape on volumetric infusion 
pump 5:4 
Audiovisual training, BUMED origins 

of 4:18 
Authors, Navy, recent articles by 7:28, 

8:9, 9:26, 11:5 
Aviation 
Blue Angels' physician 7:4 
flight personnel, medical monitoring 

of 3:8 
Koskella: one of the Navy's flying 

doctors 4:2 
Privacy Act statements in aircraft 
mishap investigations 1 :29 
Awards 
aerospace physiologists 8:28 
Billings Bronze Medal recipients 3:7 
energy conservation 4:5 

BALDWIN, R.B., VADM, USN, the 
Navy personnel situation 2:26 

Banta, G.R., LT, MSC, USN, cardiovas- 
cular conditioning/weight control 
program 7:20 



Barbados Branch Clinic closed 5:29 
Beckett, R.R., sampling for airborne 

asbestos Fibers 5:24 
Bedwetting: its origins and its cure 9:7 
Bellanca, J.J., CAPT, MC, USN 
asbestos-related diseases 5:18 
diagnosis of occupational disease 7:14 
gaining patient compliance 6:10 
managing the dissatisfied patient 7:9 
Beneficiaries 

view on medical care 2:12 
Benton, A.L., Ph.D., honored Navy 

psychologist 5:5 
Bethesda, Md., NNMC signs agree- 
ment with National Cancer Institute 
8:29 
Beth, R., JOl.USN. "Corpsman!" 11:4 
Bigley, T. J., VADM, USN, medical sup- 
port and the logistician 2: 10 
Billets, TEMAC 7:29 
Blais, B.R., CAPT, MC, USN, MSC: not 
always Medical Service Corps — 
sometimes it's Military Sealift 
Command 12:12 
Bloedorn, W.A., CDR, MC, USN (Ret.), 

in memoriam 2:28 
Boards 

certifications 4:8 

reimbursement for specialty exami- 
nations 6:8 
Bonner, K.M., ENS, NC, USN (Ret.), in 

memoriam 6:8 
Breger, E., CDR, MC, USNR 
bedwetting: its origins and its cure 

9:7 
emotional disorders of learning 12:16 
Breyfogle, W., PH2, USN, "Whirlwind 

Special" nets Navy nurses 6:2 
Brown, S.W., HMCM, USN, new direc- 
tor of Hospital Corps 6:5,7 
BUMED (Bureau of Medicine and Sur- 
gery) 
audiovisual training, origins of 4:18 
energy consumption 11:29 
reorganization 5:10 
SITREP (situation reports) 1:29, 2:29, 
3:29, 4:29, 5:29, 6:5, 7:29, 8:29, 
9:29. 10:28, 11:29, 12:28 

CARDIAC life support program at Jack- 
sonville 2:29 

Cardiopulmonary resuscitation (CPR) 
6:4 

Cardiovascular conditioning/weight 
control program 7:20 



Volume 70, December 1979 



29 



Carlton, T.G., CDR, MC, USN 
Navy psychiatric technicians in the 

outpatient setting 7:17 
SPRINT: a psychiatric contingency 
response team in action 6; 11 
Carr, J.E., CAPT, MC, USN, Medical 

Corps status report 11:12 
Cavenar, J.O., Jr., CDR, MC, USNR-R 
emotional problems after therapeutic 

abortion 4:23 
temporal lobe seizures simulating 
anxiety attacks 9:22 
Celmer, M.E., LT, MSC, USNR, team 
approach proves effective for hu- 
man relations development 3:13 
Certifications, American Board 4:8 
CHAMPUS (Civilian Health and Medi- 
cal Program of the Uniformed Ser- 
vices) 
advance approval for ETC care 11:28 
benefits for the treatment of alcohol- 
ism 6:8 
extends coverage for service-con- 
nected conditions 4:29 
handbook 3:29 

inpatient medical care charges in- 
creased 11:28 
mental health care programs 7:29 
new contractor for six states and 

Christian Science claims 4:29 
some home monitors covered 8:29 
Children 
bedwetting: its origins and cure 9:7 
cluster well-baby clinic 8:6 
emotional disorders of learning 12:16 
Natonal Children's Dental Health 

Week 1:2 
preventive family psychiatry over- 
seas: experience with a parenting 
and child development course 3:16 
Clerkships 
psychiatry 11:28 
undersea medicine 3:11 
Cold water immersion, hypothermia in 

1:27 
Cold weather medicine 
injuries, prevention of 8:28 
training 8:10 
Computer assisted practice of cardiol- 
ogy (CPOC) contract awarded 9:29 
Conder, M., RADM, NC, USN, inter- 
view 5:6 
Cooney, D.M., RADM, USN, learning 

to communicate 2:14 
Cost containment is a personal respon- 
sibility 2:1 
Cowles, S.K., LCDR, MC, USN, pulmo- 
nary function testing in the Navy 



asbestos medical monitoring pro- 
gram 6:22 

Cronin, CM., CDR, NC, USN, cluster 
well-baby clinic 8:6 

Curreri, A.R., M.D., in memoriam 6:8 

DEMBERT, M.L., LT, MC, USN 3:2 
Dentistry 
courses 1:6, 2:28 
dental assistant, Class "A" School 

9:6 
Dental Repair Technology, Class C 

School 1:4 
effects of topically applied fluorides 

on cavity preparations 3:21 
intraoral removal of a large subman- 
dibular gland sialolith 8:16 
margin placement in restorative den- 
tistry 4:26 
National Children's Dental Health 

Week 1:2 
prevention-oriented approach to den- 
tal office emergencies 10:16 
DePolo, D., Jr., LT, MSC, USN, use of 
facsimile transmitters for a clinical 
pharmacy program 4:15 
Dermatitis, occupational 1:26 
Diabetic neuropathy pamphlets avail- 
able 3:29 
Diagnostic data: a key to decision-mak- 
ing 1:24 
Diet 

nutritional support: the use of assess- 
ment principles and a nutritional 
preparation formulary 8:18 
nutrition: new component in patient 
education 3:26 
Disaster control drills for hospitals 1:12 
Diving, Navy 

equipment, old and new 10:13 
experimental system 11:2 
Lambertsen, C.J., Prof., M.D., 

awarded Mark 5 helmet 12:20 
Navy School of Diving and Salvage 
10:11 
Donehue, W.C., LT, MC, USNR, im- 
mersion hypothermia 1:27 
Drills, disaster, for hospitals 1:12 
Drugs 
AMA prescribing guidelines 9:9 
cephalosporins and aminoglycosides: 

drug use review 9:19 
protecting your prescriptions 7:19 
Duce, L.A., Ph.D., in memoriam 7:27 
Dutton, B.D., CAPT, MC, USN, re- 
fresher training for submarine hos- 
pital corpsmen: a working model 
12:18 



EBARB, W.F., HM1, USN, EMT pro- 
gram at Whidbey Island 9:2 
Education (also see training) 
Armed Forces Health Professions 

Scholarship Program 6:6 
continuing education for the Navy 

Medical Department 5:1 
dental assistant, Class "A" School 

9:6 
dental courses 1:6, 2:28 
graduate degree programs at USUHS 

2:28, 29 
graduate medical 7:10 
MSC training programs 8:26 
Nurse Corps continuing 8:14 
Nurse Corps courses 1:6, 3:6, 4:6 
programs and scholarships for the 

naval Medical Department 11:15 
psychiatry clerkships 11:28 
refresher training for submarine hos- 
pital corpsmen 12:18 
Emergencies, dental office 10:16 
Emergency medical computer mode! 

developed 1:29 
Emergency medical technician (EMT) 

program at Whidbey Island 9:2 
Emotional disorders of learning 12:16 
Energy conservation 4:5, 6:21, 6:12 
Enlisted personnel 

concerns of the enlisted community 

2:22 
hearing loss among 10:21 
Enoch, J.D., CAPT, DC, USN, flag offi- 
cer selectee 4:4 

FACSIMILE transmitters for a clinical 
pharmacy program 4:15 

Family psychiatry overseas: experience 
with a parenting and child develop- 
ment course 3:16 

Featherston, S.R., HM2, USN, inter- 
view 10:14 

Feet 
plantar wart removal, blunt dissec- 
tion technique 12:22 

Fellowship programs 1:7 

Field management of male urethritis 3:9 

Fleet Marine Force medical support 
4:29 

Flight personnel, medical monitoring of 
3:8 

Flight surgeons 
Koskella: one of the Navy's flying 

doctors 4:2 
Privacy Act statements in aircraft 
mishap investigations 1:29 

Fraser, J.R., LT, USNR, 101 days in the 
life of a destroyer doctor 7:6 



30 



U.S. Navy Medicine 



Frizzell, E.H., CAPT, DC, USN (Ret.), 

in memoriam 1:6 
Fulcher, O.H., CAPT, MC, USN (Ret.), 

in memoriam 3:6 
Funding 

managing fiscal assets 2:5 

GEMELLI, R.J., LCDR, MC, USN, pre- 
ventive family psychiatry overseas: 
experience with a parenting and 
child development course 3:16 

George, K.A., PH/JO, USN, Fort Up- 
ton Navyman: from mechanics to 
medicine 9:4 

Giusti, J.R., JOl, USN, "Eagle of the 
Sea" or "Angel of Mercy" 7:2 

Graduate medical education 7:10 

HABERKORN, S., LCDR, MSC, 

USNR-R, develops management 
information system 7:13 
Hall, C.L., Jr., LUG, MSC, USNR, use 
of facsimile transmitters for a 
clinical pharmacy program 4:15 
Hammel, K.W., the origins of BUMED 

audiovisual training 4:18 
Harold E. Holt, Naval Communication 

Station, Exmouth, Australia 5:2 
Harris, M.A., CAPT, MC, USN, tem- 
poral lobe seizures simulating 
anxiety attacks 9:22 
Harrison, W.L., LT, MSC, USN, nutri- 
tion: new component in patient 
education 3:26 
Health care 
professionalism in health care admin- 
istration 12:10 
quality 9:1, 10:1 

TEL- MED: providing information to 
the community 3:4 
Health resources management, supervi- 
sory program in 3:11 
Hearing 
aural rehabilitation 1:13 
loss among selected Navy enlisted 
personnel 10:21 
Heart 
cardiac life support program at Jack- 
sonville 2:29 
cardiopulmonary resuscitation (CPR) 

6:4 
cardiovascular conditioning/weight 
control program 7:20 
Heimlich Maneuver saves choking 

victim 3:10 
Hepatitis, viral 4:10 
Herman, J.K. 
Blue Angels' physician 7:4 



corpsman-diver speaks out 10:14 
John Paul Jones: a twentieth century 

post mortem 4:12 
NASA astronaut is a Navy medical 
officer and the first American 
physician in space 12:2 
Navy energy conservation: status 
report 6:12 
prison diary 9:12, 10:2 
RADM Conder retires 5:6 
where Navy divers learn their trade 
10:11 
Hidalgo, E., a special role 2:25 
History 

John Paul Jones: a twentieth century 
post mortem 4:12 
Holcomb, J.R., HM2, USN 9:4 
Hooper, R.R., LCDR, MC, USNR, field 
management of male urethritis 3:9 
Hospital Corps, Navy 
celebrates 81st anniversary 6:5 
"Corpsman!" 11:4 
new Director of 6:5, 7 
refresher training for submarine hos- 
pital corpsmen 12:18 
Hospital, Navy 

disaster control drills 1:12 
New Orleans leased 2:29 
outpatient clinics to replace some 
Navy hospitals 5:29 
Howard, N.S., CDR, MC, USN, the 
Navy in Antarctica: Operation 
Deepfreeze 12:8 
Human Relations Development Seminar 

3:13 
Hursig, L.S., R.D., Nutritional support: 
the use of assessment principles 
and a nutritional preparations for- 
mulary 8:18 
Hypothermia, immersion 1:27 

INFECTIOUS diseases, fellowships in 

1:7 
Ingraham, G.B. Ill, LT, DC, USNR, in- 
traoral removal of a large subman- 
dibular gland sialolith 8:16 
In memoriam 

Bloedorn, W.A., CDR, MC, USN 
(Ret.) 2:28 

Bonner, K.M., ENS, NC, USN (Ret.) 
6:8 

Curreri, A.R., M.D. 6:8 

Duce, L.A., Ph.D. 7:27 

Frizzell, E.H., CAPT, DC, USN (Ret.) 
1:6 

Fulcher, O.H., CAPT, MC, USN 
(Ret.) 3:6 

Lang, J.C., Ph.D. 11:27 



van Valkenburgh, W.G., CAPT, MC, 

USN 11:27 
Walker, R.J. Ill, CDR, USN (Ret.) 4:6 
Weems, P.V., CAPT, USN (Ret.) 7:27 

Instructions and directives 1:12, 3:8 

Insurance 

Servicemen's and Veterans Group 
Life Insurance (SGLI) 4:9 

Interviews 
Conder, M., RADM, NC, USN 5:6 
Featherston, S.R., HM2, USN 10:14 
Kerwin, J.P., CAPT, MC, USN 12:2 
Thomason, C. LCDR, MC, USN 7:4 

Intraoral removal of a large submandib- 
ular gland sialolith 8:16 

JOHNSON, R., J03, USN, the diver's 
friend 11:2 

Jones, John Paul, a twentieth century 
post mortem of 4:12 

Jones, R.S., LCDR, DC, USN, intraoral 
removal of a large submandibular 
gland sialolith 8:16 

Jose, J.B., JOC, USN, submarine doc- 
tor 3:2 

KERWIN, J.P., CAPT, MC, USN, first 
American physician in space 12:2 

Koenig, H.M., CDR, MC, USN, protec- 
tion of human subjects 11:19 

Koskella, K., LCDR, MC, USN, one of 
the Navy's flying doctors 4:2 

LABORATORY technician training, 

Navy 5:29 
Lamar, S.R., LT, MSC, USN, nutritional 
support: the use of assessment 
principles and a nutritional prepa- 
rations formulary 8:18 
Lambertsen, C.J., Prof., M.D., 

awarded Mark 5 helmet 12:20 
Land, J.C., Ph.D., in memoriam 11:27 
Legal 

international agreements 10:28 
malpractice prophylaxis 9:29 
medicine and the law 2:18 
video tapes on medicine and law 7:29 
Letters 1:21 
Liver 

hepatitis, viral 4:10 
Logistics 
medical support and the logistician 
2:10 
Lowery, C.H., RADM, MC, USN 
flag officer selectee 4:4 
recommendation made as chairman 
of the SAC XI operational medicine 
committee 11:18 



Volume 70, December 1979 



31 



Lundy, B., one of Navy's flying doctors 

4:2 
Lungs 
occupational lung disease 12:26 
pulmonary function testing in Navy 
asbestos medical monitoring pro- 
gram 6:22 
Supercourse • in lung disease 9:27 

MACDONALD, G.R., Jr., CDR, MC, 
USNR, how I manage the patient 
with urethral discharge 9:24 
Malpractice prophylaxis 9:29 
Management 

managing fiscal assets 2:5 
team approach proves effective for 
human relations development 3:13 
Managing the dissatisfied patient 7:9 
Mannitol injection 25 percent 12:25 
Marine Corps, U.S. 
construction of new wing to Branch 

Hospital 5:29 
medical support for Marines 2:8 
McArthur, R.E., LT, DC, USNR, effects 
of topically applied fluorides on 
cavity preparations 3:21 
McCarthy, M.M., LTJG, MSC, USNR. 
team approach proves effective fot 
human relations development 3:13 
McDowell, C.E., RADM, JAGC, USN, 

medicine and the law 2:18 
McKown, F.C., CDR, NC, USN, con- 
tinuing education in the Nurse 
Corps 8:14 
McManamon, T.V., CAPT, MC, USN, 

occupational lung disease 12:26 
Medical Corps, Navy, status of 11:12 
Medical Department, Navy 
advanced health policy and planning 

course 1:29 
current status of manpower 11:9 
educational programs and scholar- 
ships for 11:15 
Medical program planning, issues in 2:7 
Medical Service Corps, Navy 
ACHA admits MSC members 1:20, 

12:10 
education and training programs 8:26 
Military Sealift Command 12:12 
progress and plans of 8:2 
training courses available 12:21 
update of preference cards 9:29 
Medicine and the law 2:18 
Meetings 
Aerospace Medical Association 4:7 
Association of Military Surgeons of 

the U.S. 8:27 
National Council on Alcoholism 3:29 



New Orleans Graduate Medical As- 
sembly 3:7 
Obstetrics and Gynecology 4:8 
Regional Medical Record 1:23 
SAC XI (Specialties Advisory Confer- 
ence 11:6 
Surgeon General's conference for 
commanding officers 2:2 

Meyers, A.W., CDR, MSC, USN 
prison diary 9:12, 10:2 

Micrographics 1:14 

Military reference books 6:9 

Military Sealift Command 12:12 

Mohler, C.B., CDR, MSC, (Ret.), edu- 
cational programs and scholarships 
for the naval Medical Department 
11:15 

Munro, D.L., LCDR, NC, USN, TEL- 
MED: providing health care infor- 
mation to the community 3:4 

Murray, K.M., developed technique to 
enhance faint photo images 6:8 

Museles, M., RADM, MC, USN, cur- 
rent status of Medical Department 
manpower 11:9 

NASA astronaut, CAPT J.P. Kerwin, 

MC, USN 12:2 
National Children's Dental Health 

Week 1:2 
National Library of Medicine 

exhibit on aviation medicine 4:28 
Navy authors, recent articles by 7:28, 

8:9, 9:26, 11:5 
Nelson, P.D., CAPT, MSC, USN, Medi- 
cal Service Corps: progress and 
plans 8:2 
Newport, R.I., new dental center dedi- 
cated 2:29 
Newsmakers, NAVMED 1:22 
Nolan, R.W., medical care: the bene- 
ficiaries' view 2:12 
Nurse Corps, Navy 
Conder, M., RADM, NC, USN, inter- 
view 5:6 
continuing education 1:6, 3:6, 4:6, 

8:14 
health care administration program 

12:28 
nursing procedures manual, new 9:28 
recruiting tour 6:2 

West Coast Nursing Symposium 7:28 
Nutrition 
new component in patient education 

3:26 
use of assessment principles and a 
nutritional preparations formulary 
8:18 



W1C (Women, Infants and Children's 
Special Supplemental Food Pro- 
gram) in operation 5:23 

OBESITY program at NRMC Orlando 

5:29 
Occupational medicine 
course 1:7 

diagnosis of occupational disease 7: 14 
lung disease 12:26 
role of 11:1 

skin disease, prevention of 1:26 
smoking, adverse health effects of 5:9 
workshop 11:27 
Ochs, C.W., CAPT, MC, USN (Ret), 
roentgenographic findings of as- 
bestos exposure 5:20 
Olszak, H.A., HMCM, USN, concerns 

of the enlisted community 2:22 
Operational planning 2:21 
Operation Deepfreeze 12:8 
O'Shanick, G.J., M.D., emotional prob- 
lems after therapeutic abortion 
4:23 
Otolaryngology committee, finding of 

11:18 
Otto Fuel II 1:5 
Overseas living, adjustment to 9:10 

PAGE, J.C., the prevalence of hearing 
loss among selected Navy enlisted 
personnel 10:21 
Parsons, W.M., CDR, MSC, USN, a 

profile of viral hepatitis 4:10 
Patient care 
gaining patient compliance 6:10 
managing the dissatisfied patient 7:9 
Pay, variable incentive (VIP) 12:28 
Pediatrics (see Children) 
Personnel, Navy, situation of 2:26 
Peters, E.L., CDR, NC, USN, immer- 
sion hypothermia 1:27 
Peterson, M.W., LT, MC, USNR, ad- 
justment to overseas living 9:10 
Pharmacology 
AMA prescribing guidelines 9:9 
cephalosporins and aminoglycosides: 

drug use review 9:19 
mannitol injection 25 percent 12:25 
prescriptions 7:19 
Pharmacy Service 
facsimile transmitters for a clinical 
pharmacy program 4:15 
Physical examinations 
ACDUTRA 6:7 

periodic physicals on personnel re- 
tained on the temporary disability 
retired list required 10:28 



32 



U.S. Navy Medicine 



Physicians 

a special role 2:25 
the impaired professional 3:1 
Physician's Assistants (PAs) 
aboard carriers 8:29 
program reinstituted 1:29 
Plantar wart removal, blunt dissection 

technique 12:22 
Postdoctoral associateships 11:27 
Prendergast, R.K., HM2, USNR-R, 
EMT program at Whidbey Island 
9:2 
Preventive and occupational medicine 

course 1:7 
Preventive medicine activities in asso- 
ciation with Hurricane David 11:29 
Prison diary 9:12, 10:2 
Project Handclasp 4:25 
Protection of human subjects 11:19 
Psychiatry 

bedwetting: its origins and its cure 

9:7 
Psychiatry clerkships 11:28 
emotional disorders of learning 12:16 
emotional problems after therapeutic 

abortion 4:23 
Preventive family psychiatry over- 
seas: experience with a parenting 
and child development course 3:16 
SPRINT: a psychiatric contingency 

response team in action 6:11 
technicians in the outpatient setting 

7:17 
temporal lobe seizures simulating 
anxiety attacks 9:22 
Public affairs — an all hands evolution 

4:1 
Publications, recent by Navy authors 
7:28, 8:9, 9:26, 11:5 

QUANTICO, Va., medical screening 

program 8:15 
Quinn, J. J., CAPT, MC, USN 

diagnostic data: a key to decision- 
making 1:24 
operational planning 2:21 

RADIOLOGY 
NRL-developed method enhances 

faint photo images 6:8 
roentgenographic findings of asbes- 
tos exposure 5:20 

Records, medical diagnostic data 1:24 

Redmond, C.R., DN, USN, saves chok- 
ing victim 3:10 

Reference books, military 6:9 

Rehabilitation, aural 1:13 

Reorganization, BUMED 5:10 



Research 

biomedical projections 3:29 
postdoctoral associateships 11:27 
Reserve, Naval 

Haberkorn, S„ LCDR, MSC, USNR-R 
develops management information 
system 7:13 
medical program 7:13 
vital part of the Total Force concept 
8:1 
Residencies 
and fellowship programs 1:7 
programs 3:7, 5:4 
Resuscitation efforts save a life 11:22 
Ridley, M.T., CDR, DC, USN, intraoral 
removal of a large submandibular 
gland sialolith 8:16 
Riley, P.T., LCDR, MSC, USN, use of 
facsimile transmitters for a clinical 
pharmacy program 4:15 
Robertson, R.M., Ph.D., the prevalence 
of hearing loss among selected 
Navy enlisted personnel 10:21 
Roberts, W.M., ENS, MC, USNR, 
ACDUTRA option: orientation at 
sea 1:9 
Roentgenographic Findings of asbestos 

exposure 5:20 
Rubella among hospital personnel and 

patients 10:28 
Roster, key Medical Department per- 
sonnel 11:23 

SAC (see Meetings) 
Safety 

Otto Fuel II 1:5 
Sampson, R.N., LT, MSC, USN, screen- 
ing of alcoholism 6:26 
Scabies 10:29 
Scholar's Scuttlebutt 

101 days in the life of a destroyer 

doctor 7:6 
ACDUTRA option: orientation at sea 

1:9 
AFHPSP student air travel within 

CONUS 10:27 
clerkships in undersea medicine 3:11 
information assistance for the Armed 
Forces Health Professions Scholar- 
ship Program 6:6 
physical examination before ACDU- 
TRA 6:7 
Servicemen's and Veterans Group 

Life Insurance (SGLI) 4:9 
supervisory program in health re- 
sources management 3:11 
Seminars 
Asbestos Associated Diseases 9:28 



Human Relations Development 3:13 
Uniform Chart of Accounts 2:29 

Servicemen's and Veterans Group Life 
Insurance (SGLI) 4:9 

Shannon, P. A., LT, MSC, USN, the 
move to micrographics 1:14 

Shea, F.T., CAPT, NC, USN, flag offi- 
cer selectee 4:4 

Shepherd, D.. LCDR, MSC, USN, team 
approach proves effective for hu- 
man relations development 3:13 

Shore establishment realignment ac- 
tions 7:29 

SITREP (see BUMED SITREP) 

Skin disease 

preventing occupational skin disease 

1:26 
scabies 10:29 

Small, W.N., VADM, USN, issues in 
medical program planning 2:7 

Smith, J.P., CAPT, MC, USN, roent- 
genographic findings of asbestos 
exposure 5:20 

Smoking 
adverse health effects in the occupa- 
tional environment 5:9 
in BUMED command activities 1:12 

Snowden, L.F., LGEN, USMC, medical 
support for the Marines 2:8 

Spinks, G.J., LT, MSC, USN, profes- 
sionalism in health care adminis- 
tration 12:10 

SPRINT: a psychiatric contingency re- 
sponse team in action 6:11 

Steele, S.M., Jr., CDR, MC, USN, Navy 
urology: a status report 11:17 

Still, K.R., LTJG, MSC, USNR, sam- 
pling for airborne asbestos fibers 
5:24 

Strom, C.G., CAPT, MC, USN, findings 
of the otolaryngology committee 
11:18 

Students (see Scholar's Scuttlebutt) 

Submarine doctor 3:2 

Sullivan, E.J., CDR, MC, USN, MSC: 
not always Medical Service Corps 
— sometimes it's Military Sealift 
Command 12:12 

Symposia 

Gastrointestinal Endoscopy for the 

Surgeon 7:27 
West Coast Nursing 7:28 

TALC poudrage 11:29 

Taska, R.J., M.D., emotional problems 

after therapeutic abortion 4:23 
Taylor, E.L., CDR, MC, USN, Navy 

graduate medical education 7:10 



Volume 70, December 1979 



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33 



U.S. NAVAL PUBLICATIONS and FORMS CENTER 
ATTN: CODE 306 
5801 Tabor Avenue 
Philadelphia, Pa. 19120 
Official Business 



POSTAGE AND FEES PAID 

DEPARTMENT OF THE NAVY 

DoD-316 



CONTROLLED CIRCULATION RATE 




Technicians, Navy 

emergency medical 9:2 
laboratory 5:29 
psychiatric 7:17 
TEL-MED: providing health care infor- 
mation to the community 3:4 
Temporal lobe seizures simulating anx- 
iety attacks 9:22 
Thomason, C, LCDR, MC, USN, the 

Blue Angels' physician 7:4 
Tittmann, F.R., LT, MSC, USN, team 
approach proves effective for hu- 
man relations development 3:13 
Training (also see Education) 

advanced health policy and planning 

course 1:29 
AF1P courses 1:6, 3:6, 5:4 
alcohol programs 1:6, 5:5 
cold weather medicine 8:10 
continuing education for the Navy 

Medical Department 5:1 
dental assistant, Class "A" School 

9:6 
dental continuing education 1:6, 2:28 
design and analysis of scientific ex- 
periments course 4:7 
executive medicine 11:29 
graduate degree programs at USUHS 

2:28, 29 
graduate medical education 7:10 
health care administration program 

for Nurse Corps officers 12:28 
internal medicine course 6:9 
Laboratory technician, Navy 5:29 
lung disease Supercourse 9:27 
medical effects of nuclear weapons 

course 10:28 
MSC courses available 12:21 



MSC education programs 8:26 
Navy School of Diving and Salvage 

10:11 
Nurse Corps continuing education 

1:6, 3:6, 4:6, 8:14 
preventive and occupational medicine 

course 1:7 
psychiatry clerkships 11:28 
residency and fellowship programs 

1:7,3:7 
spirometry testing course 4:7 
strategies of care for the cancer pa- 
tient 5:4 
submarine hospital corpsmen 12:18 
University of California courses 4:7, 

7:28, 8:28, 9:27 
withdrawal from part-time outservice 

courses 9:28 
Transmitters, facsimile, for a clinical 

pharmacy program 4:15 
Travel 

AFHPSP student air travel within 

CONUS 10:27 
Tuberculosis control program analysis 

completed 6:6 

UNDERSEA medicine (also see Diving, 
Navy) 
clerkships in 3:11 
Uniform Chart of Accounts seminars 

2:29 
Uniformed Services University of the 
Health Sciences (USUHS) 
graduate degree programs 2:28, 29 
Urethral discharge 9:24 
Urethritis, male, field management of 

3:9 
Urology, Navy, status report of 11:17 



VAN VALKENBURGH, W.G., CAPT, 

MC, USN, in memoriam 11:27 
Volumetric infusion pump 5:4 

WALKER, R.J. Ill, CDR, USN (Ret.), in 
memoriam 4:6 

Warcholak, R.A., LT, MSC, USN, a 
podiatric blunt dissection technique 
for plantar wart removal 12:22 

Warts, plantar, blunt dissection tech- 
nique for removal of 12:22 

Watko, L.P., LCDR, MSC, USN, field 
management of male urethritis 3:9 

Weems, P.V., CAPT, USN (Ret.), in 
memoriam 7:27 

Weight 
cardiovascular conditioning/ weight 

control program 7:20 
obesity program at NRMC Orlando 
5:29 

Whiten, R.E., LT, MSC, USNR, a quali- 
tative and quantitative drug use 
review: cephalosporins and amino- 
glycosides 9:19 

Williams, C.E., Ph.D., the prevalence 
of hearing loss among selected 
Navy enlisted personnel 10:21 

Wilson, A.C., RADM, MC, USN, 
managing fiscal assets 2:5 

Winterholler, B.W., LT, DC, USNR, a 
critical look at margin placement in 
restorative dentistry 4:26 

X-RAYS 

NRL-developed method enhances 
faint photo images 6:8 

roentgenographic findings of asbes- 
tos exposure 5:20 



U.S. NAVY MEDICINE